As an educator and scientist, it is my goal for students to think critically. For the courses I teach, those issues pertain to energy intake and energy expenditure. Thus, to have them thinking outside the box, I decided to initiate a “diet” concept that originated during discussions with my graduate students a few years ago. The premise of the project is to better understand dietary energy and its effect on health outcomes. The question being, does it matter where our energy is derived if we meet the recommended daily allowance of essential nutrients? To that end, it is often recommended to avoid foods containing refined grain, added sugar, and solid fats (e.g., grain-based desserts like cookies and cakes) as some have labeled them as obesigenic. Thus, those foods were the centerpiece of my daily “menu.”
In an attempt to meet other nutrient needs (protein, vitamins, and minerals), I included a few low-calorie vegetables, whole milk, and a multi-vitamin/mineral supplement (one to two per day). Energy intake was set at 1,800 kcals/day. The limit was selected as an amount I thought I could maintain with minimal effort, yet would still allow for relatively rapid weight loss (1–2 kg/wk). It was designed so that on most days meals or snacks would consist of 400–450 kcals of energy consumed four times throughout the day. Exercise was a part of my lifestyle, but at a level below what is recommended as I only exercised 60–90 min/wk (cycling, walking, and resistance training).
The initial duration of four weeks was selected based on issues pertaining to the structure of the class. That duration was long enough to elicit change, but short enough to be able to discuss the outcomes early in the semester. Also, data indicate that foods containing SoFAS (solid fats and added sugar) lead to detrimental outcomes relative to markers of cardiovascular disease especially lipid-lipoproteins. The duration was extended once the public interest increased. To highlight other aspects of energy balance and obesity issues, it was decided to continue that eating behavior until my body mass index (BMI) was in the “healthy” range of 18.5–25 kg/m2.
Results to Date: My BMI is 25.8 kg/m2 and my body weight has decreased by 10 kg (22 lbs). After four weeks (mid-September), body fat decreased by 5.4 kg (12 lbs). The markers of heart disease risk all improved as total cholesterol, LDL cholesterol, triacylglycerol, total:HDL ratio, triacylglycerol:HDL ratio all decreased 20–30% and HDL-cholesterol increased 5%. These variables will be reassessed once my BMI is < 25 kg/m2 and again after additional 4 weeks of weight maintenance (mid-November).
Implications: Assuming that decreasing weight in order to no longer be overweight is healthy, does it matter how we get there? Do biomarkers play a role in that answer? In other words, if I had posted my results (body composition and CVD biomarker changes) without posting how those results were achieved would most consider my health to improve? I would speculate that most would consider my health was improved, or at least my risk for cardiovascular disease was decreased.
With the global effort to reduce obesity, the overwhelming message is to decrease weight—not body fat, yet that is presumed to be the meaning. Given the public intensity to reverse increasing BMI values, it might be presumed that any means to do so should be supported. If all means are not acceptable, then the public health message must change to reflect that the means are as important, if not more so, than the ends.
If the method is important, how are we to know what methods are acceptable or recommended? That is, it seems to be that health and healthcare costs are key outcome variables. If a method leads to improved valid outcome variables, should that method be considered healthy even if it contradicts current recommendations?
Mark Haub, Ph.D.
Dept. of Human Nutrition
Kansas State University