We have a guest post today, from Matthew Papaconstantinou, Ph.D. Dr. P was born and raised in Greece. As a biologist and native of the Mediterranean basin, he closely follows the latest research on the health benefits of the Mediterranean Diet and its use as part of a behavioral weight loss program. He has a blog at his website, WeightLossTriumph.com.
As a result of the rapid rise in obesity during the last decade, it is now estimated that one-half of all US adults are overweight or obese . These statistics reflect in the number of gastric bypass surgeries, which skyrocketed from 20,000 in 1995 to 171,000 in 2005.
Although surgical and pharmacological interventions have been successful in treating obesity and preventing its commorbidities, behavioral weight loss approaches that focus on diet and exercise are considered the most effective treatments for obese people.
Behavioral weight loss programs aim at helping participants modify their eating and exercise habits through a number of educative sessions with nutritionists, exercise physiologists and behavioral therapists. However, for the treatments to be effective, the patients must complete the program. Attrition is one of the major problems of behavioral programs as the number of people who drop out can be as high as 80%.
Using The Mediterranean Diet (MD) as Part of Behavioral Weight Loss Treatment
A recent study by Corbalan et al. evaluated the effectiveness of a behavioral therapy program that was based on the principles of the MD for treatment of obesity . The purpose of this study was to assess whether this program can help participants lose weight and to determine the main obstacles to weight loss.
Why The MD?
Why did they choose the MD as part of this behavioral program? Well, an extensive body of scientific research has shown that the MD is related to lower occurrence of obesity.
MD Promotes Weight Loss
The ATTICA study is a good example . This study, conducted in 2006, evaluated the nutritional habits of 3042 inhabitants of the province of Attica (Athens, Greece), by means of a diet score that incorporated the inherent characteristics of this diet. An inverse correlation between Body Mass Index (BMI) and adherence to the MD was observed—the higher the MD score, the lower the prevalence of overweight, obesity, and central adiposity was.
Of course, it has been suggested that it is not the MD that protects people from obesity, but other aspects of the MD lifestyle (i.e, engagement in outdoor activities, less stress, etc) that may lower BMI levels. Interestingly, the Attica study found that the inverse association between MD adherence and obesity holds true even after adjusting for potential confounders, such as physical activity status. This is a great indication that the Mediterranean diet alone protects against obesity.
It is interesting to note here that, for the majority of the Mediterranean basin inhabitants, the dietary intake is nowadays far from the MD dietary recommendations. This explains why 27% of males and 39% of females living today in the Greek Mediterranean islands are obese . Forty years ago, farmers from the island of Crete had one of the healthiest lifestyles compared to other participants of the “Seven Countries Study” . Today, mean weight has increased by 44lb, placing more than 80% of Cretan farmers in either the obese or overweight category .
But lets continue on the objective of the Corbalan study. Can an MD-based cognitive behavioral therapy be used for the treatment of obesity? What are the main obstacles to weight loss in a Mediterranean population?
This study recruited 1406 Spanish people who were all overweight or obese, aged 20-65 years old. The program lasted for 34 weeks and consisted of 4 components.
• Behavioral techniques—keeping dietary records and change the immediate environment in a way that is conducive to weight loss
• Physical activity—30 minute moderate intensity activity, 3 times a week (10,000 steps a day)
• Nutritional education—basic concepts in nutrition
• Diet—the Mediterranean Diet
Participants consumed 1351 calories per day. This was 67% of their normal daily energy intake, before the program began. The macronutrient components of the MD were 30-35% fat, 50% carbs, and 15-20% protein and the participants were instructed to use olive oil as the only source of cooking fat. The subjects were also advised to consume at least 300 g of fruits and unrestricted amount of vegetables.
At the end of the treatment, participants lost on average 17.2 lb. The attrition was as low as 4%, which shows that the participation and adherence was far superior than that observed for other cognitive-behavioral techniques.
Based on a questionnaire that the subjects completed, a “Barriers to Weight Loss” score was calculated, which allowed the investigators to identify which were the main barriers to losing weight. “Loss of motivation”, “stress-related eating” and “eating when bored” were the most common obstacles experienced by those who did not achieve their weight loss goal.
On the other hand, those who succeeded by losing at least 10% of their initial weight, adopted the habit of “writing down absolutely everything”. This allowed them to be aware of what they were eating, control their behavior and monitor their progress.
The study concluded that “behavioral therapy, accompanied by food habit control, caloric reduction, and balanced nutrient distribution based on the Mediterranean diet is useful for weight loss and the improvement of certain alterations associated with obesity.”
This is the first study to show that a dietary/behavioral treatment based on the MD is effective and can be used in clinical practice.
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