2013 Australian & New Zealand Weight Loss Leaders Summit (Sydney) Dr Joanna McMillian is one of Australia’s best-known nutrition and healthy lifestyle experts, and is an author of several books including the award winning Inner Health Outer Beauty and the internationally published The Low GI Diet. In her insightful presentation Dr Joanna will reveal: The controversies in weight loss diets, the facts and the myths. Food is more than the nutrients it contains – this information is a MUST for educating your clients. A template for healthy eating, what does the doctor recommend? Helping your clients take control of their own diet and lifestyle.

1. Get Lean, Stay Lean
Dr Joanna McMillan
getlean.com.au

2. Factors affecting weight
control
support
motivation
happiness
cultural
backgroun
d
sleep
stress
Energy in
Energy
out

3. Risk factors for
overweight/obesity
High fat diet
No high
intensity
exercise
Low dietary
calcium
Short sleep
High
disinhibition
eating
behaviour
Lower socioeconomic
status
Family
lifestyle
Prevalence of
obesity in
family & friends
genetics

4. “eat less and move
more?”
If only it were that
simple.

5. It IS harder for some
Twin studies show us that
susceptibility to gaining weight
with overfeeding & sensitivity to –
ve energy balance from exercise
is genetically determined
“There are individuals at risk of
gaining weight and body fat or
who are resistant to weight loss”
Bouchard & Tremblay 1997 J Nutr
127:943S

6. We are all individuals

7. Sleep & weight control

Short sleep duration increases risk of weight gain

Quebec Family Study: combination of short sleep +
a disinhibition eating trait 2.5x as likely to be
overweight & gained weight & waist circumference
over 6 yrs (Chaput et al 2011, Sleep 34:1291)

8. Sleep & weight gain
short
duration
sleepers
sleep to 7-8hrs
maintained short
sleep
after 6 yrs
Greater
increase
in BMI &
fat mass
Chaput et al 2012 Int J Obesity 36:7526

9. Sleep & alcohol intake
Odds ratio for
exceeding
weekly
recommendatio
n for alcohol
•
•
•
•
Adults sleeping ⩽6h/night consume more alcohol than those
sleeping ⩽7h/night.
Short sleepers exceed the recommendations for sensible
weekly alcohol intake.
The prevalence of binge drinking is more common in men than
women.
Short sleepers with a high disinhibition eating behaviour trait
consume more alcohol.
Chaput et al 2012 Appetite 59; 650655

10. Dieting leads to unfavourable eating
behaviours
uncontrolled
eating disinhibition
rigid control
of eating
History of dieting associated with rigid
control & disinhibition
 Harms long-term regulation of weight

Gallant et al 2012 Br J Nutr
14;108:1976-9

11. Sedentary behaviour

In older Japanese population, less TV ass. with
lower risk of overweight, independent of
meeting exercise guidelines (Inoue et al 2012 J
Epidemiol 22:50-6)
Breaking up
sedentary activity
reduces waist
circumference
(Owen et al Exerc Sport Sci
Rev 2010;38:105-13)

12. Sitting & mortality
1.6
1.4
1.2
1
0.8
0.6
0.4
0.2
0
mortality
CVD
Increased daily sitting time

13. Diets to get lean?
All diets work in the short term, but
none of them work in the long-term

14. Is Paleo the way forward?
Little change to human genome during
last 10,000 yrs
Our diet & lifestyle progressively more
divergent from our ancient ancestors
“Socially, we are people of the 21st
century, but genetically we remain citizens
of the Paleolithic era” Loren Cordain
Is our high rate of
hypertension, CVD, diabetes & metabolic
syndrome the result of this?

15. What is a Paleo diet?

Most studies have estimated diets for 229 populations… i.e
there is not one paleo diet, but many

Diets varied depending on geographical location, seasonality

Our ancestors essentially adapted to whatever food was
available

The ability of humans to adapt to a number of different diets is
undoubtedly part of our relative success as a species

But common features all their food came from hunting
(animals & birds), gathering (wild plants & small land fauna) &
fishing (including shell fishing)

16. Modern Paleo… is it true Paleo?

Foods including bacon, butter, sausages & ham were not consume

Not just the lean fillet consumed – bone marrow, organ
meats, smaller animals etc.

Even vegetables today are far different – all influenced by
agriculture

Debate over when grains were introduced

Watch paleontologist Christina Warriner “debunking the paleo diet”

17. Comparison of diets
paleo
low-carb
low-fat
Mediterranea
n
protein
high
mod
low
mod
cho
mod
low
high
mod
fat
mod
high
low
mod
sfa
mod
high
low
low
mufa
high
mod
low
mod
omega-3
high
low
low
high
fibre
high
low
high
high
fruit & veg
high
low
high
high
nuts & seeds
mod
low
low
mod
salt
low
high
low
mod
GL
low
low
high
low
closest to paleo
O‟Keefe JH & Cordain L, 2004 Mayo Clin Proc 79;101-

18. Can we use Paleo with our
clients?





The idea sells.. particularly to
men
Minimising processed food –
great
Overly restrictive – poor long
term compliance
Use aspects & then modify
Include (ancient)
wholegrains, legumes, dairy –
in „close-to-nature‟ forms

19. Intermittent fasting






Eat what you like for 5 days
& on 2 non-consecutive
days you fast
Long term compliance?
Effect of gene expression?
Do we just train ourselves
to get better at dealing with
famine?
Nutrient intakes?
I‟m not convinced

20. My Get Lean Plate Model
getlean.com.au

21. Pack your vase with
nutrient-dense foods
& don‟t waste space
on kJ without
nutrients
Don‟t fill
up if
trying to
utilise fat
stores
Overflo
w goes
to fat
stores

22. Carbs are not a food group





Teach clients carbohydrate is a
macronutrient ie a fuel for our bodies
30% of blood glucose goes to fuel brain
Essential for endurance & tough training
sessions “when the going gets tough, the
tough eat carbs” Louise Burke
Cannot put all foods containing carbs in one
basket
Moderate intake of low GI quality carb-rich
foods

23. GI is a tool – not the central
mechanism
Not all low GI foods are smart choices e.g. icecream is clearly not best food for getting lean!
 Use it to choose between nutrient-rich foods
 Fibre, nutrient-density & other nutritional factors
important
 Keep it simple – no need to know the numbers


24. Diogenes – diet best to stay lean?
LP-HGI &
Control
Most Weight
Regain
HP or LGI
alone
moderate
benefit
0.93 kg less
gain in HP &
0.95 kg less
in low GI
HP-LGI
best
Larsen et al 2010 NEJM
363;2102

25. Staying lean: importance of selfmonitoring
N=3003 consistent self-weighing improved
weight loss maintenance
 “catch weight gains before they escalated”
 Decreasing self-weighing frequency
associated with greater weight gain

Obesity 2007 Dec;15(12):3091-6

26. Long-Term Maintenance
Study
To maintain their weight loss, subjects report
 high levels of physical activity ( approximately 1 h/d)
 eating a low-calorie, low-fat diet
 eating breakfast regularly
 self-monitoring weight
 maintaining a consistent eating pattern across weekdays and
weekends.
Weight loss maintenance may get easier over time; after individuals
have successfully maintained their weight loss for 2-5 yrs, the
chance of longer-term success greatly increases.
Continued adherence to diet and exercise strategies, low levels of
depression and disinhibition, and medical triggers for weight loss
are also associated with long-term success.
Am J Clin Nutr. 2005 Jul;82(1 Suppl):222S-225S.

27. Who succeeds in staying
lean?
More initial weight loss
 Reaching selfdetermined goal
weight
 Active lifestyle
 Regular meals
including breakfast
 Healthier eating
 Control of over-eating
 Self-monitoring of
behaviours

Internal motivation
 Social support
 Better coping
strategies
 Ability to handle stress
 Self-efficacy
 Autonomy
 Assuming
responsibility in life
 Psychological strength
& stability

Obes Rev 2005 Feb;6(1):67-85

28. Who is more likely to regain?
History of weight cycling
 Disinhibited eating
 Binge eating
 More hunger
 Eating in response to
negative emotions &
stress
 Passive reactions to
problems


29. Take home points
Getting lean & staying lean is not as simple as
eating less & moving more
 It is harder for some than others
 Protein rich, moderate carbs, healthy fat
 Vase analogy – fill with nutrient-dense foods
 Rigid eating plans leads to disinhibition &
overeating
 Monitor progress & maintenance
 Support from peers & family
 Good sleep essential
 Manage stress & work/life balance
 It‟s a complete lifestyle


30. Thank you 
getlean.com.
au