Meal replacements (MRs) for weight loss Do they work, and are they safe?
to not only provide nutritional balance,
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viable in some cases of extreme obesity,
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results from this, expected at the World
German scientists have shown that
in metabolic rate. If a full weight loss
from MRs without apparent side effects. a high level of greenery are three
program is not built around this, it can
times more likely to be active and
products as a tool in the weight loss battle.
40% less likely to be obese. Those For reference: who live with lots of graffiti, litter Research evidence and dog poo are 50% less likely to (Who says science is not creative?)
strategy: meta and pooling analysis from
six studies. International Journal of Reasons for past concern
be made up of rather bland ‘milkshape’
in this issue
type powders with little concern for total
nutritional balance. They have also been
are not found in a low calorie diet. MRs
meals during the day. Finally, there has
– or even a diet meal – and hence can
been little emphasis put on supervision,
hence often leading to a ‘bounce back’
Which MRs? Getting the best from
There are really only three MR versions recommended by the Professor (none of
your meal replacements which he has any commercial interest in). Dr McCloud’s is the brand name given to a
Here are some suggestions for optimizing the weight loss effects of meal
product produced by a Queensland GP, and
replacements:• Use once or twice a day instead of meals that are most easy to replace;
only available through doctors. It has a large
• Mix shakes with low fat or skim milk, if not satisfying with water;
number of flavours and types – perhaps too
• Use quality products that are properly nutritionally balanced (see table);
• Use fruit and low calorie foods as snacks;
Optifast, is the oldest of the commercial
• Use 2 replacements per day more often for weight loss, then 1/day
MRs, but is suffering by not having changed
its formulation for years. It’s also a bit bland,
• When full meals are taken, make sure these are still low energy and not
but does have different flavours, and has
Examples from the Frontline: KicStart is produced by a Sydney-based
Ted Anderson from Mona Vale NSW who has lost over 15kg in 6 months
pharmacy product development team. It is
says meal replacements have been the big breakthrough for him: “They’re
well balanced, perhaps the most tasty, and
FRQYHQLHQWEXWDOVRÀOOLQJµKHVD\V´6XUSULVLQJO\P\ZLIHZKRWKRXJKW,
has extra ingredients like omega 3/omega 6
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fats in a healthy ratio. There is currently only
Greg Nielsen from Epping says meal replacements help keep him on
one flavour, but flavour sachets are soon to
track; “It’s easy to just take in too much in this day and age. With meal
be added to ‘custom make’ your own taste.
replacements, you know you’re not pigging out, but you’re also not craving
sachet or meal, and these generally come
John Mesites from Manly says MRs now make weight loss easier: “These
in boxes (except Dr McCloud’s) of around
weren’t around when I did GutBusters years ago, but they make it a hell of a
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Obesity and the Metabolic Syndrome
The bad news is that being overweight can cause disease.
Testing for the Metabolic Syndrome
Now the even more bad news is that there is a group of
Diabetes scientists meeting in Brussells recently have pulled
these diseases that occur more commonly together in
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overweight people, which can lead to even bigger problems.
to come up with one universal description and cut-offs. The
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seminal medical presentation in the 1980s. It was thought
to be a cluster of disease risks like blood
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than or equal to 94 for Europid men and greater than or
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• raised serum triglyceride levels (>1.7mmol/L)
• reduced serum HDL cholesterol (<1.03 mmol/L in males
• raised blood pressure (systolic >130mmHg or
diastolic >85mmHg) or treatment of previously diagnosed
• impaired fasting blood sugars 9>5.6mmol/L) or previously
Take home message:
Metabolic syndrome, which consists of a pot belly and 2
other risks, is a cause for concern.
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For reference:
categorization linking obesity with diabetes, and variously
Zimmet PZ and others. Mainstreaming the metabolic
called ‘diabesity’ (as most, but not all type 2 diabetes is
V\QGURPH$GHÀQLWLYHGHÀQLWLRQMedical Journal of Australia, 2005;183(4):175-176. Being active to go Coffee consumption may help diabetes
been adopted but just about all cultures
– hence the interests in its effects.
10 points for both systolic and diastolic
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blood pressure after the dark chocolate,
but not after the white. The ‘bad’ (LDL)
best, controlled studies of caffeine and
insulin resistance, which is a pre-cursor
with diabetes. They found there was a 35% less risk of getting the disease
Cholesterol lowering margarines do work
day. The results were consistent across several countries.
existed, it was only in over 60 year-olds,
Also it didn’t occur with instant coffee,
claims this is not an excuse for pigging
doesn’t have to be taken off the list for
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slight positive effect on weight loss, it
Take home message:
chocolate is also bitter sweet and is not
Caffeine could be helpful for diabetics.
likely to be eaten in large amounts. It’s
For reference:
weight loss – at least unless other foods
gram per serving of plant sterols,
and risk of type 2 diabetes: a systematic
Take home message: for a daily total intake of at least in saturated fat and cholesterol, … and dark chocolate For reference: could also help with blood disease.” What they haven’t said
pressure
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at Tufts University in the US have found
Hypertension, 2005; 46: 398-405. Factors influencing body Don’t be afraid to pump a fat levels bit of iron as you get older
of weight training (WT) in body fat loss.
like walking, because it helps maintain,
another. Some of this may be genetically
(because muscle is ‘active’), and thus,
things that can’t be changed – at least
theoretically at least, burn more energy.
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PRUHDSSUHFLDWHGDWWKHVFLHQWLÀFOHYHO
It gives a hint to people that they’re not
always to blame for their own excess fat. Accept some increases in body fat with age
It’s natural to add a little fat to the
Accept (and understand) your physical limitations
effects have been less obvious, but this
• a decreased sensitivity of fat cells
‘weight control’ programs. Everybody
• decrease of a muscle protein that helps
these – including being comfortable at a
higher than normal, but healthy, level of
Change the things you can, but accept the things you
• increased eating (although this is often
can’t change
gains with aging don’t appear to be as
dangerous as those in the young. They can
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be worse though if the gains are too much
(i.e. more than 20lbs over the weight at
These are listed in the table below.
age 20), so some caution is still needed. Calculate your required daily TRIM’S TRIVIA Being overweight can food intake change your stature It’s probably just common sense,
You can estimate the amount of food you need daily to stay at the same weight
but researchers in Brazil (Clinical
by detailed and complicated laboratory analyses, or it can be estimated through
Biomechanics, July 62005) have found
formulae, such as those below for males and females.
that being overweight is likely to lead to stature changes that can cause a
Resting Metabolic Rate (RMR):
Males: 66 + (6.22 x wt(lbs)) + (12.7x ht(inches)) - (6.8 x age)
Females: 655 + (4.36 x wt(lbs)) + (4.32 x ht(inches)) - (4.7 x age)
From the estimated metabolic rate, you can see that even a 50kg woman
requires around 1200kcals per day to balance metabolism in the resting state. So
In measuring intervertebral disc height,
any diet of less than 1200kcals is likely to lead to weight loss.
Special calculations are then needed to estimate the extra requirements for
carrying the load, but the obese men’s
physical activity carried out throughout the day. Again, the general consensus
is that for even a sedentary person, the RMR should be multiplied by about 1.2,
when they weren’t carry an extra load.
whereas an extremely vigorous person may require a multiplier of more. A table
showing the energy required at different levels of exertion is shown below:
Nicotine replacements
Seated with no option of moving and little exercise
lead to less weight gain
Seated work with requirement to move around
when quitting
Standing work (e,g, housework, shop assistant)
Indeed evidence suggests this is true because of (a) a decrease in metabolism
7KHÀQDOÀJXUHKHUHLVWKHQXPEHURIFDORULHVSHUGD\\RXQHHGWRVWD\DWWKHVDPH
weight. Consuming less will lead to weight loss. Check your genetic limitations quitting. But some help comes from
a study of post menopausal female quitters in Minneapolis who were given
Although not a guaranteed measure of heritability, the following test can give you
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for two week after quitting (AddictiveBehaviour, 2005 Aug;30(7):1273-80.). The nicotine patch group gained
1. As far as you know, were either or both of your parents
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Surprisingly, the nicotine group actually
ate more than the others, suggesting that
2. Do you have any brothers or sisters who have been
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Aging means losing fitness quicker
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older and younger men, researchers in the
UK have found that the effects of aerobic
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younger men (British Journal of Sports Medicine, 2005 Aug;39(8):561-4.).
suggests a similar phenomenon in gaining
5. Where do you mainly get fat when you put on weight?
ÀWQHVVEuropean Journal of Applied Physiology, 2005 Jul 20). The positive
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reduced insulin resistance (a pre-cursor
Scores: 0-4: No apparent genetic involvement. 5-7: Moderate hereditary component. 8-10: There
of diabetes) for up to 72 hours in young
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women, but this is not the case in older
special help for effective weight loss.
women. Unfortunately age is one of those risk factors that just can’t be changed. Maintenance the best way to keep kilos off
The importance of maintenance has been accentuated in
program, having lost an average of 44 lb — about 20% of
a new American Study to Prevent Regain (STOP Regain)
their total body weight — in a variety of ways. The most
developed by Dr Rena Wing, one of that country’s leading
common methods were Weight Watchers, their own diets,
weight control experts. Preliminary results from the study,
which offers counselling and face-to-face contact as well as
Take home message:
Internet support, show that 42% of people given little help
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other than a newsletter in the maintenance stage, regain
2.2kg (5lbs) or more, 6 months after starting a program. Of those given counselling, only 26% regained that amount,
For reference:
as did 32% of those given ongoing advice over the Internet.
Wing R. North American Association for the Study of
Participants were highly motivated upon entering the
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…and the best advice for keeping it off
He’s said it in these pages before, but the Professor’s
statement is worth repeating: ‘Anyone can lose weight. It’s
Third, you will need a lifetime commitment to long-term
keeping it off that’s the problem’. So how is this best done?
physical activity. As the risk of regain is greater for anyone
And is it different to the initial stage of losing?
who has been overweight, the ex-obese need more of this
The best evidence comes from the study of those who
than someone who has never had a weight problem. Sixty
have done it successfully over the long-term. Entrants in a
to 90 minutes of accumulated activity is the amount now
US Weight Loss registry, comprised of over 5,000 people
considered essential to prevent regain.
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Fourth, and perhaps paradoxically, those who eat
breakfast keep their lost weight off better than those who
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don’t. This is probably because they eat less for the rest of
the longer this is kept off. After 2 years, the game gets
easier, but before this, the risks of regain are great as the
Fifth, self-monitoring, by measuring and recording what
body tends to want to get back to the weight it once new,
you do, like steps per day etc., seems to have a positive
and which it thinks is best for long term survival (in case of
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for dealing with stress, that reduce the risk of compensatory
Secondly, a diet low in energy density (particularly fat)
eating in these situations seems to help.
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Once you have lost the weight, putting these six things
through any combination of nutrients that reduce volume
together should help you keep it off longer – hopefully, until
(ie. low carbohydrate, low protein), over 95% of the registry
that fateful day when weight loss becomes automatic!
OLots of different species live longer when fed less food (calories). Some, like the fruit fly, live longer when fed less of different types of calories, SWEET CHILLI AND ONION DIP like sugar vs yeast (PloS Medicine, (Makes approximately 3 cup servings)2005;2(8):721-723). This begs the question whether certain nutrients may be more important for longevity in humans – a question now being put to the test in the U.S. Stand by for the ‘Fruit Fly Diet Plan’.
2 tbs sweet chilli relish½ tsp onion powder
OThe state of Oregon was the only state in the US not to increase its
1. Mix together onion and water in a microwave safe container
levels of obesity in the last year.
2. Cook on high for 3 minutes, or until onion
is tender. Rinse onion in cold water to cool. urban design and the fact that many
3. Meanwhile, process the cottage cheese until
to work than in other states. Could
4. Place in chilli relish, onion powder and
it also be that Oregon is about as
SURFHVVXQWLOÀQHO\FKRSSHGEXWQRWVPRRWK
you can get, while still being in the
5. Serve chilled with crudites or rice crackers.
the band. Hence it’s thought that tactile
year or two – so don’t go crazy on the
were carried out suggest that although it
… where the Professor takes the bit Q. How much should I
you’ll continue to gain. Ultimately then,
realistically expect to lose if I Q. As a diabetic I can go serious on a weight loss understand how glycaemic program like yours? index is important for diabetes, but I notice you’re now
much as you want’. But that would also
concentrating on this for weight
because it won’t necessarily happen, but
loss. How does this work? A. Good question. In fact it’s one where
very low levels of internal or ‘visceral’
fat – which is one of the most dangerous
quite like the taste of this by the way!).
of factors, like genetics, how long they
rate in this group. For all these reasons
do to try to lose it. The average weight
active is necessary, but don’t sweat on
enough to get a big increase in health (in
Q. I’ve been told about a new
about a 30% decrease in disease risk). type of surgery for weight loss
however (Journal of Internal Medicine,
which is very non intrusive and somehow uses small shocks on the stomach. Can you tell me something about
only predictor of success at the start of
lead to a greater feeling of satiety. This
because it’s still very early days for
expected to lose less at the start, actually
related to blood sugar levels (as well as
other factors) and when this drops below
left inserted just below the skin. Every
from high GI foods), there is a tendency
to want to eat more. Simple, isn’t it?
Q. I’m a big bloke. Always have been. But my doctor tells me I’m perfectly healthy. So is
is all it takes – leads to a reduction in
you ‘burn off’ more fat. There’s less
there any real reason for me to
evidence for this, but it’s a distinct
lose weight?
this is probably also the way laproscopic
weight control experts (yes, it’s true,
to think that this just reduced the size of
suggests a genetic cause for your obesity.
What types of exercise help? OMNIs and NOMOI’s: “Any exercise which increases his Proof that fat doesn’t always cardiac output, the ability of his heart to mean unhealthy, and lean pump blood, will be extremely helpful. doesn’t always mean healthy If he does exercises that involve the lower part of his body, involving the quadriceps and hamstrings and lower back, you’re going to promote blood
weight is not a health problem, and another group who suffer the problems
On drug use (Viagra, Cialis etc)
“A lot of men don’t appreciate that you actually need sexual stimulation for these drugs to work. Taking the medicine (For men only) is not going to induce an erection. What Does hard = healthy? the medicines do is facilitate an erection in an appropriate setting, so stimulation
It’s well known that one of the adverse
is absolutely necessary in order for the erection to occur. As men get older
erectile dysfunction (ED). This is often
they actually need more sensory and physical stimulation in order to achieve On the ‘hardness’ diet
“First thing is reduce your portions
damaging than the weight they carry. – start having less to eat. Let’s reduce
author of a new book called Sexualthe fat in your diet. When you eat fat, Fitness for Men: The Hardness Factorwhat you’re basically doing is stunning your blood vessels. If you stun the blood vessels, they can’t open and close and they can’t be as elastic as they would be under normal circumstances. If you draw blood on somebody who has had a
“Once men understand the connection big meal, the blood is milky, it’s opaque. between health and virility, they will That’s due to the triglycerides that are circulating. You want to try to reduce the
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total amount of fat and sugar in the diet.
internal, or ‘visceral’ fat which is
…On the other hand, if you enrich your diet with foods of color — green, orange,
fat around the organs, like liver, kidneys
UHGIUXLWVYHJHWDEOHVÀEHU³,WKLQNyou are actually going to enhance the
pushed into the blood stream in response
quality of your health and subsequently,
It’s not clear what proportions of the
On why ED occurs with age “Erections change over time, they On other supplements change with every decade of a man’s
“You want to start to use some of the life, as every other organ changes. That antioxidants, the Pycnogenol, the organ has to age and be affected by arginine, the omega-3s. And niacin is illness and vascular disease and stress a fantastic substance that raises your good cholesterol and lowers your bad On the value of lifestyle change cholesterol. Have some green tea, “If he is able to exercise and lose weight probably the healthiest drink I know ofµ
at the same time, he’s going to free On sex and longevity up some testosterone which will now
“It appears as though the men who have enhance his sexual performance and his
relax until you’ve had everything tested.
more regular sex seem to be healthier and seem to live longer. There’s the On how often good news -- good sex may actually “…every man (should) have an erection cause good health. And the reverse may every day of his life. This is not intended to mean that he needs to be having sex For more information: For reference: every day, it means that he should be Lamm S. biologically healthy enough to have an or
www.WebMD.com. erection every day because that would imply the integrity of his blood vessels, The Professor’s Comment:
Karelis AD and others. Diabetes and his nerves, his hormones and his brain.”
56 | EDGE INTERNATIONAL REVIEW EDGE INTERNATIONAL REVIEW | 57 By Ger y Riskin the problem lies with the ways in which thecompensation process plays out, including expecta-tions of partner behavior and the communicationof the process by which a figure is reached. e result is that if you ask any individual partner to describe the compensation system,you will get a unique interpretat