Journal of Cardiovascular Nursing
Vol. 30, No. 3, pp 184Y185 x Copyright B 2015 Wolters Kluwer Health, Inc. All rights reserved.
Progress in Prevention Effectiveness of Popular Weight Loss Diets on Cardiovascular Risk Reduction Jane Nelson Worel, MS, RN, APN-BC, FAHA, FPCNA; Laura L. Hayman, PhD, RN, FAAN, FAHA
Y
our patients are excited to tell you they are ready to work on weight loss in an effort to reduce their risk for heart disease. They are planning to follow a popular weight loss diet promoted in a best-selling book or offered by a commercial vendor. How likely are they to be successful in achieving and maintaining their desired healthy weight? Will the diet they plan to embark on likely result in cardiovascular risk reduction as measured by improvements in blood pressure, lipids, glucose, and hemoglobin A1c levels? Do you cheer them on and support their efforts? Or, try to steer them in a different direction? Recent data from the National Health and Nutrition Examination Surveys estimate that 69% of adults in the United States are obese or overweight with approximately 35%
Jane Nelson Worel, MS, RN, APN-BC, FAHA, FPCNA Nurse Practitioner, Phases Primary Care for Women, Madison, Wisconsin.
Laura L. Hayman, PhD, RN, FAAN, FAHA Associate Vice-Provost for Research and Professor of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston. The authors have no funding or conflicts of interest to disclose.
Correspondence Jane Nelson Worel, MS, RN, APN-BC, FAHA, FPCNA, Phases Primary Care for Women, 2955 Triverton Pike Dr, Madison, WI 53711 ([email protected]). DOI: 10.1097/JCN.0000000000000260
obese.1 Overweight is defined as a body mass index (BMI) of 25 kg/m2 to 29.9 kg/m2; and obesity, as a BMI of 30 kg/m2 or greater. The high rates of overweight and obesity raise public health concerns because of their strong association with chronic diseases. Hypertension, dyslipidemia, type 2 diabetes mellitus, coronary heart disease, stroke, osteoarthritis, sleep apnea, and some cancers are linked to obesity.2,3 In addition, obesity is associated with higher cardiovascular disease (CVD) and all-cause mortality when compared with those considered to be at normal weight (BMI, 18.5Y24.9 kg/m2).2,3 One of the clinical questions addressed in the 2013 American Heart Association/American College of Cardiology/The Obesity Society Obesity Guideline was ‘‘Among overweight and obese adults, does achievement of reduction in body weight with lifestyle and pharmacologic interventions affect CVD risk factors, CVD events, and morbidity and mortality?’’3 The writers of the Guideline completed a comprehensive review of the scientific literature and determined that sustained weight loss of 3% to 5% of body weight would likely result in meaningful reductions in several CVD risk factors including triglycerides, blood glucose, hemoglobin A1c, and the risk for developing type 2 diabetes mellitus. Weight loss greater than 5% will reduce blood pressure, improve low-density
lipoprotein cholesterol, and highdensity cholesterol.3 Given the benefits of weight loss on CVD risk reduction, healthcare providers are tasked with prescribing dietary strategies and other lifestyle interventions that will be safe and effective for patients. The writers of the Obesity Guideline recommend a variety of dietary approaches to weight loss including general caloric restriction to restriction of certain food types (high-carbohydrate, lowfiber, or high-fat foods) to create an energy deficit. In addition, the writers of the Guideline recommend commercial-based weight loss lifestyle interventions, particularly if there is peer-reviewed published evidence of their safety and efficacy.3 The challenge is to find quality evidence, with outcome data, to endorse or prescribe popular weight loss diets to patients as a strategy for weight loss and CVD risk reduction. The long-term effects of 4 popular diets (Atkins, South Beach, Zone, and Weight Watchers) were the subject of a recently published, systematic review of randomized controlled trials by Atallah and colleagues4 at McGill University and the Jewish General Hospital in Montreal, Quebec, Canada. Atkins5 is a lowcarbohydrate diet with unlimited protein and fat; South Beach6 is a low-carbohydrate diet that focuses on lean proteins, monounsaturated or polyunsaturated fats, and low-glycemic
184 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Invitation Only-Progress in Prevention Due First of the Month 185
index carbohydrates. The Zone7 is a low-carbohydrate diet that recommends the consumption of low-fat proteins, low-glycemic load carbohydrates, and small amounts of ‘‘good’’ fat. Weight Watchers is a lifestyle intervention program that uses a point system to provide caloric restriction while supporting participants in weekly weigh-in and group educational sessions.8 All 4 popular diets produced similar, modest shortterm (
Vol. 30, No. 3, pp 184Y185 x Copyright B 2015 Wolters Kluwer Health, Inc. All rights reserved.
Progress in Prevention Effectiveness of Popular Weight Loss Diets on Cardiovascular Risk Reduction Jane Nelson Worel, MS, RN, APN-BC, FAHA, FPCNA; Laura L. Hayman, PhD, RN, FAAN, FAHA
Y
our patients are excited to tell you they are ready to work on weight loss in an effort to reduce their risk for heart disease. They are planning to follow a popular weight loss diet promoted in a best-selling book or offered by a commercial vendor. How likely are they to be successful in achieving and maintaining their desired healthy weight? Will the diet they plan to embark on likely result in cardiovascular risk reduction as measured by improvements in blood pressure, lipids, glucose, and hemoglobin A1c levels? Do you cheer them on and support their efforts? Or, try to steer them in a different direction? Recent data from the National Health and Nutrition Examination Surveys estimate that 69% of adults in the United States are obese or overweight with approximately 35%
Jane Nelson Worel, MS, RN, APN-BC, FAHA, FPCNA Nurse Practitioner, Phases Primary Care for Women, Madison, Wisconsin.
Laura L. Hayman, PhD, RN, FAAN, FAHA Associate Vice-Provost for Research and Professor of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston. The authors have no funding or conflicts of interest to disclose.
Correspondence Jane Nelson Worel, MS, RN, APN-BC, FAHA, FPCNA, Phases Primary Care for Women, 2955 Triverton Pike Dr, Madison, WI 53711 ([email protected]). DOI: 10.1097/JCN.0000000000000260
obese.1 Overweight is defined as a body mass index (BMI) of 25 kg/m2 to 29.9 kg/m2; and obesity, as a BMI of 30 kg/m2 or greater. The high rates of overweight and obesity raise public health concerns because of their strong association with chronic diseases. Hypertension, dyslipidemia, type 2 diabetes mellitus, coronary heart disease, stroke, osteoarthritis, sleep apnea, and some cancers are linked to obesity.2,3 In addition, obesity is associated with higher cardiovascular disease (CVD) and all-cause mortality when compared with those considered to be at normal weight (BMI, 18.5Y24.9 kg/m2).2,3 One of the clinical questions addressed in the 2013 American Heart Association/American College of Cardiology/The Obesity Society Obesity Guideline was ‘‘Among overweight and obese adults, does achievement of reduction in body weight with lifestyle and pharmacologic interventions affect CVD risk factors, CVD events, and morbidity and mortality?’’3 The writers of the Guideline completed a comprehensive review of the scientific literature and determined that sustained weight loss of 3% to 5% of body weight would likely result in meaningful reductions in several CVD risk factors including triglycerides, blood glucose, hemoglobin A1c, and the risk for developing type 2 diabetes mellitus. Weight loss greater than 5% will reduce blood pressure, improve low-density
lipoprotein cholesterol, and highdensity cholesterol.3 Given the benefits of weight loss on CVD risk reduction, healthcare providers are tasked with prescribing dietary strategies and other lifestyle interventions that will be safe and effective for patients. The writers of the Obesity Guideline recommend a variety of dietary approaches to weight loss including general caloric restriction to restriction of certain food types (high-carbohydrate, lowfiber, or high-fat foods) to create an energy deficit. In addition, the writers of the Guideline recommend commercial-based weight loss lifestyle interventions, particularly if there is peer-reviewed published evidence of their safety and efficacy.3 The challenge is to find quality evidence, with outcome data, to endorse or prescribe popular weight loss diets to patients as a strategy for weight loss and CVD risk reduction. The long-term effects of 4 popular diets (Atkins, South Beach, Zone, and Weight Watchers) were the subject of a recently published, systematic review of randomized controlled trials by Atallah and colleagues4 at McGill University and the Jewish General Hospital in Montreal, Quebec, Canada. Atkins5 is a lowcarbohydrate diet with unlimited protein and fat; South Beach6 is a low-carbohydrate diet that focuses on lean proteins, monounsaturated or polyunsaturated fats, and low-glycemic
184 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Invitation Only-Progress in Prevention Due First of the Month 185
index carbohydrates. The Zone7 is a low-carbohydrate diet that recommends the consumption of low-fat proteins, low-glycemic load carbohydrates, and small amounts of ‘‘good’’ fat. Weight Watchers is a lifestyle intervention program that uses a point system to provide caloric restriction while supporting participants in weekly weigh-in and group educational sessions.8 All 4 popular diets produced similar, modest shortterm (
