Weight Loss Programs Weight Watchers, Jenny Craig, Nutrisystem 2

Comparing Weight Loss Diets: The truth behind the hype Jim Painter, PhD, RD Americans spend $40 billion a year on weight-loss programs and products.

http://www.businessweek.com/debateroom/archives/2008/03/the_diet_industry_a_big_fat_lie.html Todays plan

1. Weight loss programs Weight watchers, Jenny Craig, Nutrisystem 2. Low carb Atkins, Zone, South Beach, Paleo 3. Low fat Ornish 4. How well do they work? 5. What works Why people follow a diet

• Appearance/weight loss • Health • Dr.’s orders • Disease/health conditions Dieting Trends

Commercial dieters were less likely to include a physical activity regime while dieting compared to those following the dietary guidelines

Men Women

• Typically older • More likely to • Former smokers select commercial • Overweight/obese programs • Infrequent dieters • Follow multiple diet programs

Julia, C., Peneau, S., Andreeva, V., Mejean, C., Fezeu, L., Galan, P., & Hercberg, S. (2014). Weight-loss strategies used by the general population: How are they perceived? Plos One, 9(5), e97834.

Consumers Perceived Importance of Diet Information

Scientific publications

Government websites

Online support groups Very important Private health organizations Somewhat important Manufacturers websites Not important

TV or other media

Popular books

0 20 40 60 80

Feinman R, Vernon M, and Westman E. 2006. Truth #1

Consider the source of your info. Motives and scope of knowledge Celebrity Endorsements

Collins, C., Morgan, P., Jones, P., et al. Evaluation of a commercial web-based…. BMC Public Health. 2010;10: 669-676., Freedhoff, Y., & Sharma, A. "Lose 40 pounds in 4 weeks”....Can Med Assoc J. 2009;180(4):367., Koche, L. Obesity and its treatments: An overview. Your Weight Matters Magazine. n.d.;, Franz, M., VanWormer, J., Crain, A., et al. Weight-loss outcomes: A systematic review… J Am Diet Assoc. 2007;107(10):1755-1767., Weight watchers homepage. Web site., Nutrisystem homepage. Web site., Jenny craig homepage. Web site., Leske, S., Strodl, E., & Hou, X. A qualitative study of the determinants of dieting….BMC Public Health. 2012; 12(1): 1086-1098., Moisio, R., & Beruchashvili, M. Questing for well-being at weight watchers…. J Consum Res. 2010;36(5):857-875.,Pinto, A., Fava, J., Hoffmann, D., & Wing, R. Combining behavioral weight loss treatment….. Obesity (Silver Spring). 2013;21(4): 673-680., Lowe, M., Kral, T., & Miller-Kovach, K. Weight-loss maintenance 1,2, and 5 years…Br J Nutr. 2008;99(4):925-930., References cont, in Notes.

Weight loss Programs Program Weight Loss Length of Best for Entry Requirements Credentials of leaders Claim program Patient who Jenny Craig 1-2lbs per Until weight-loss Is looking for Medical History -Internally trained consultants week is met structured program background (former clients who were with flexibility built questionnaire successful in the program) and in program directors -Attend 48-hour training session with ongoing monthly continuing education classes Nutrisystem 1-2lbs per 28-day cycles Looking for a more Internally trained internet and week until weight loss private weight loss phone consultants is complete experience that None includes a MR diet No requirements to go to a clinic, weigh in, or classes Weight 1-2lbs per Forever – Looking for weekly Lifetime members (successful Watchers week behaviors are meetings, group None members who reach their goal taught to keep a support, weigh ins weight and complete 6-week portioned diet maintenance phase, who then must stay within 2lbs of goal) who receive leadership training

Weight watchers homepage. Web site., Nutrisystem homepage. Web site., Shuman, J. Weight-loss programs: Is one right for you?. Am J Nurs.1993;93(5):70-73. Hubbard, B. Commercial program and product review: Meal replacement-based weight-loss programs. Obes Manag. 2007;292-295. Leavell, A. Commercial program and product review. Obes Manag. 2008;250-256. Medifast homepage. Web site. Coleman, C., Kiel, J., Hanlon-Mitola, A., et al. Use of the medifast meal replacement programs for weight loss in overweight and obese clients: A retrospective chart review of three medifast weight control centers (mwcc). Food Nutr Sci. 2012;3:1433-1444. Koche, L. Obesity and its treatments: An overview. Your Weight Matters Magazine. n.d.; Pre-made meals

Get a personal consultant

At home or In-Center option

Pick a program • Pros Weight is lost when following program, having a counselor holds people accountable, little planning and food preparation

• Cons Does not teach healthy lifestyle habits, hard to eat out • Has been around for 40 years.

• Gourmet, fresh-frozen cuisine entrees created by Chefs.

• Has a separate plan for both males and females.

• My Daily 3 Fitness Program • Nutrisystem D is for those with type 2 diabetes Nutrisystem PCD VS DSE

8.2

7 6 PCD 5 DSE 4

Weight lost in in kg lost Weight 3 0.6 2 1 0 0-3 Months

Foster GD, Borradaile KE, Vander SS, Shantz KL, Dilks RJ, Goldbacher EM, Oliver TL, LaGrotte CA, Homoko C, Satz W. The effects of a commercially available weight loss program among obese patients with type 2 diabetes: a randomized study. Postgraduate Medicine. 2009; 121(5).

Nutrisystem PCD VS DSE

9.7

10 9

8 5.3

7 PCD 6 DSE 5 4

3 Weight lost in kg lost Weight 2 1 0 3-6 Months

Truth #2

Sustainable Portion control is key! • Pros • When meals are eaten weight is lost, study shows it is good for Type 2 Diabetics

• Cons • Does not teach healthy eating habits, gain weight once you go off of it, hard to eat out

Four Pillar approach

Healthy weight loss Fits into your life Informed choices A holistic view PointsPlus Value Each person has a PointsPlus Target

Encourages Weight Watchers Power foods. Weekly PointsPlus Allowance WW Good Health Guidelines

• Include at least 5 servings of fruits and vegetables (9 if you weight more than 350 pounds). • Have at least 2 servings of milk; 3 if you are a nursing mom, a teenager, are over 50 or weigh more than 250 pounds. • Drink at least 6 glasses of nonalcoholic drinks.

• Eat a serving or two of a protein-rich food.

• Take a multiple vitamin-mineral supplement.

• Limit added sugars, sodium and alcohol. • Have 2 teaspoons of healthy oil, including olive, canola, sunflower, safflower, or flaxseed. • Choose whole-grain foods whenever possible.

• Aim to get at least 30 minutes of moderate-intensity activity.

“Diet Trials” Study

4 Weight 3 Watchers Control Group

2 Weight lost in kg lost Weight 1

-1 0-2 Months 2-6 Months 0-6 Months

Truby H, Baic S, deLooy A, Fox KR, Livingston MBE, Logan CM, Macdonald IA, Morgan LM, Taylor MA, Millward J. Randomised controlled trial of four commercial weight loss programmes in the UK: initial finding from the BBC “diet trials.” BMJ. 2006. Weight Watchers VS Self-Help Program

Heshka S, Anderson JW, Atkinson RL, Freenway FL, Hill JO, Phinney SD, Kolotkin RL, Miller-Kovach K, Pi-Sunyer FX. Weight loss with self- help compared with a structured commercial program a randomized trial. JAMA. 2003;289(14):1792-1798.

Truth #3

General information doesn’t work! A specific sustainable plan is needed! • Pros • Promotes healthy lifestyle changes, support group, encourages physical activity, provides maintenance program, online tools for members • Cons

• Public weigh in, set meetings may be difficult to fit into schedule Low-Carb Diets Program Weight Loss Claim Length of Best for Entry Credentials of leaders program Patient who Requireme nts The Zone Diet “The Zone Diet, including our Lifetime Struggle with None PhD (website along with his high-quality Omega-3 fish oil illnesses CV and biography do not say supplement, is the fastest way to caused by what his PhD is in) reduce the inflammation in your inflammation body that comes from what you eat.” South Beach 8-13lbs in phase 1 Phase 1- 2 weeks Anyone None Doctor 1-2lbs per week in phase 2 Phase 2- until goal weight is reached Phase 3- forever

Paleo Diet -Reduce your risk of heart disease, type 2 Forever or until Need None - Ph.D. in Health diabetes, and most chronic degenerative health goals are straightforward - M.S. in physical diseases that affect people in the western education world reached. Diet instructions on was designed to what they can - B.S. in exercise science •Lose weight if you are overweight - M.S. in Human Nutrition •Improve your athletic performance follow indefinitely and cannot eat •Slow or reverse progression of an and Food Quality, autoimmune disease nutrition consultant •Improve or eliminate acne - Ph.D. in Physiology •Sleep better and have more energy - Ph.D., in Nutritional throughout the day Biochemistry and •Enjoy an increased libido Physiology •Improve your mental outlook and clarity •Enjoy a longer, healthier, more active life

Atkins Diet You’ll see results quickly. Even after just a few Permanent Wants meals None - PhD, RD, M.S. days, your clothes will fit better! You’re never hungry. In fact, you’re eating lifestyle change mailed to them - Physician in Obesity every two to three hours. and counts Management You don’t have to exercise. While it’s a good carbs - Professor in the idea to exercise for other reasons, on Atkins you can still lose weight without exercise. Department of As you approach your weight loss goals, you'll Nutrition and add more fruits, starchy veggies, and whole Exercise Physiology grains. It’s easy to stick with the Atkins weight loss program. This is a delicious and satisfying way of eating you can live with. Atkin’s Diet

• Started by Dr. Robert C. Atkins • After studying articles published in the Journal of the American Medical Association he formalized the controlled carbohydrate approach. • By limiting refined carbohydrates and eating the right foods. Ones body changes from a carb- burning to a fat-burning machine. • Consists of Four Phases. Atkins- What is it?

– May include unlimited portions of meat, poultry, fish, cheese, and eggs – Restricts fruits, many vegetables, grains and milk products ( limit CHO intake to as little as 20 grams per day) – Multi-vitamin/multi- mineral supplement is recommended – Basis that carbohydrates are bad and cause weight gain

Atkins Diet

• No fat or pro limitations (esp. sat fat) • Recommends healthier fat options • Recommends vitamin & mineral supplement • Popular not only in U.S. but also Australia • “Excess calories add lbs only when you are

eating a lot of CHO along with fat” (Dr Atkins)

Atkin’s Diet Phase 1- Objectives of Induction

• 1. To switch your body from burning primarily carbohydrates to burning primarily fat for energy. • 2. To jump-start weight loss.

Initially consume only 20 g of Net Carbs per day. Atkin’s Diet Phase 2- Ongoing Weight Loss

Objective To find how many carbs you can consume while continuing to lose weight, keep your appetite under control and feel energized.

• Gradually up Net Carb intake, starting at 25 g of Net Carbs. • Continue to stay in control of your appetite as you lose weight. • Slowly and safely increase the variety in your diet, usually starting with small portions of nuts an seeds, following the Carb Ladder. • Find your Carbohydrate Level for Losing. • Decided when to move on to Phase 3, Pre-Maintenance.

Atkin’s Diet Phase 3- Pre-Maintenance • This phase starts when you only have 10 pounds left to lose. Objectives

1. Lose the last 10 pounds-slowly. 2. Test your carb tolerance. 3. Test your tolerance for additional foods. 4. Find personal carb Balance/Atkins Carbohydrate Equilibrium (ACE). 5. Maintain control-and weight Atkin’s Diet Phase 4- Lifetime Maintenance Objectives

1. Take charge of weight-for a lifetime. 2. Show the World you can stick with it. 3. Make adjustments as needed. 4. Take charge of your health. 5. Get support-and give it too.

“Diet Trials” Study

3 Atkin's Diet

2 Control Group Weight lost in kg lost Weight 1

-1 0-2 Months 2-6 Months 0-6 Months

0 2 6 12 0

-1

-2

-3 Atkin's Diet LEARN

-4 Weight lost in kg lost Weight -5

-6

-7

Gardner CD, Kiazand A, Alhassan S, Kim S, Stafford RS, Balise RR, Kraemer HC, King AC. Comparison of the atkins, zone, ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women the a to z weight loss study: a randomized trial. JAMA. 2007; 297(9):969-977.

Atkin’s Diet • Pros • Online tools, do lose weight when following program, only need book for info on program

• Cons

• Not sustainable. Very limited variety of food and food cravings. “Diet Trials” Study

4 Atkins Diet Weight Watchers 3 Slim-Fast

2 Control Group Weight lost in kg lost Weight 1

-1 0-2 Months 2-6 Months 0-6 Months

Diets do not work! The reverse J curve The South Beach Diet The Plan’s Principles

1. The doctor-designed South Beach Diet plan.

2. You don’t have to count calories, carbohydrates, fat grams, or anything else.

3. The South Beach Diet is flexible.

4. The South Beach Diet is a lifestyle.

5. Weight loss is only one of the many benefits. South Beach Diet- What is it? • Different than the Atkins diet because the “right carbs” are pushed rather than no carbs • Promises that individuals won’t “suffer any hunger pains” and his/her cravings for sweets will “virtually disappear” • Promotes high fiber carbohydrates, health unsaturated fats, lean sources of protein and low-fat dairy products • Three diet phases • During each phase 20 minutes of daily exercise is recommended South Beach Diet • Emphasizes specific CHO (low GI foods) & fat (healthier fat options) • Recommends lean protein sources • “The most important outcome of the 1st phase is eliminating cravings for sugar that previously resulted from reactive hypoglycemia & insulin resistance” • (Dr. Agaston)

Foody et al, 2006. •2 week period •Restricts foods including fruit and whole grain •NOT a well- PHASE 1 balanced diet eating plan • Lasts as long as the person wants • Adds fruit and whole grains back • Not clear to find a time PHASE 2 frame for this phase of the diet to be followed •Weight maintenance phase •Typical day (1500 PHASE 3 kcals): 3 meals and 2 snacks Fact or Fiction Study

• Assessed the quality of nutrition facts in the South Beach Diet using support in peer-reviewed literature as a measure of quality. • 42 nutrition facts were included. – 14 supported Supported Not Supported – 7 not supported Both No related papers – 18 both supported and not supported – 3 no related papers 7%

33%

• Over 67% of nutrition fats in the book 43% may not be supported in peer- reviewed literature. 17%

Goff SL, Food JM, Inzucchi S, Katz D, Mayne ST, Krumholz HA. Brief report: nutrition and weight loss information in a popular diet book: is it fact, fiction, or something in between?. J Gen Intern Med. 2006; 21: 769-774.

South Beach Diet

• Pros • Claims it is a lifestyle, is flexible, and is easy to follow

• Cons • Information in book may not be accurate, low in CHO in phase 1 Health Claims

• Foods high in CHOs send blood sugar too high and fast causing blood sugar to plunge and can lead to hypoglycemia

• Eliminates “calorie counts” and “portion sizes” Research Findings

Overall lack of proof

Zone Diet- What is it?

• Originally developed to treat cardiovascular patients by Mr. Sears • Key to diet is thinking hormonally and not calorically • 40-30-30 diet • Credited for Olympic swimming team

Zone Diet • Recommends: – 40% CHO – 30% Protein – 30% Fat • For every meal consume: – Protein size of palm & CHO twice the size of pro portion Zone Diet • Emphasizes whole grain CHO, lean protein, and unsaturated fat choices • Minimizes saturated fat intake • Restricts simple CHO intake • Higher in pro and fat compared to other diets

• Claims the body is genetically programmed to function ideally when a specific ratio of macronutrients are consumed

ͽ Weight loss is not dependent on the composition of the diet as long as the total energy intake is adequately reduced

ͽ Very restrictive eating regimen

ͽ Overblown health claims- misinterpreted scientific facts/ not peer reviewed

• Specifically, endurance athletes require daily intakes of carbohydrate far in excess of Zone Diet recommendations • Zone Diet proponents claim the diet showed that a higher fat and lower carbohydrate diet enhanced oxygen uptake and improved endurance.

- Diet provided 3500kcal/day, 6.7g/kg/day carbohydrates (438g/day). The experiment included more than double the carbohydrate content allotted in the Zone Diet.

• Keeping food simple (like hunters-gatherers) leads to weight loss and better health

• Fundamental principle of the Paleo diet: to protect the lining of the gut by eliminating foods that damage it - Grains, legumes, and dairy lead to leaky gut due to lectins present in the foods

• Paleo diet places emphasis on higher fat, lower carbohydrate diets

Ballantyne, S. (2004, January 11). How do grains, legumes, and dairy cause a leaky gut? Retrieved October 13, 2014, from The Paleo Mom website: http://www.thepaleomom.com/2014/01/ lectins-bad.html Acceptable Not Acceptable • Honey • Grains • Celery • Dairy products • Eggs • Legumes • Pineapple • Processed foods • Carrots •Nightshades (tomatoes, • Chicken breast/ pork jalapeño peppers, eggplant, tenderloin bell peppers, paprika, baking • Vinegar dressing potatoes, goji berries) • Vegetables •Sugar

Ballantyne, S. (2004, January 11). How do grains, legumes, and dairy cause a leaky gut? Retrieved October 13, 2014, from The Paleo Mom website: http://www.thepaleomom.com/2014/01/ lectins-bad.html

Frassetto, L., Schloetter, M., Mietus- Synder, M., Morris, R., & Sebastian, A. (2009). Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet. European Journal of Clinical Nutrition, 63, 947-955.

Paleo Food Pyramid

• Paleo diet bans all calcium-rich dairy, grains abundant in fiber, and legumes packed with protein • Modern lifestyles are not the same as paleolithic times. • Genetics and metabolism has changed • Many people were likely to die before age 15 during the paleolithic era • The proportions of vegetables and meats that hunters and gatherers consumed are not clear • Study found evidence of probable or definite atherosclerosis in 47 of 137 mummies from different geographical regions

Jabr, F. (2013, June 3). How to really eat like a hunter-gatherer: Why the paleo diet is half-baked. Retrieved October 13, 2014, from Scientific American website: http://www.scientificamerican.com/ article/why-paleo-diet-half-baked-how-hunter-gatherer really-eat/

Thompson, R., Allam, A., Lombardi, G., Wann, S., Sutherland, L., Sutherland, J., . . . Thomas, G. (2013). Atheroscleoris acrss 4000 years of human history: The horus sutdy fof four ancient populations. The Lancet, 1-12. http://dx.doi.org/10.1016/S0140-6736(13)60598-X

Smallest concern: Beef Largest concern: Decreasing fat 22% Avoiding sugar intake 8% 10% 5% Butter Bacon 22% 9% 22%

Feinman R, Vernon M, and Westman E. 2006 Reported Weight Lost and Diet Length among Low- CHO dieters

≥ 24 mo (%)

≥ 12 mo (%)

≥ 6 mo (%)

Mean (months) Women ≥ 30 lb lost (%) Men ≥ 20 lb lost (%)

No wt lost (%)

Mean (lb)

0 10 20 30 40 50 60

Ainsworth et al, 2006. Truth #5

We are eating too many carbs! Reducing carbs is beneficial. Low Fat Diet Created by Dean Ornish, professor of medicine at the University of California, to achieve weight loss and prevent chronic disease

Places focus on Nutrition (low- fat diet) Exercise Stress management Emotional support

Avoid all meats, oils- including avocados, Eat low dairy or nonfat dairy products in olives, nuts, seeds, full-fat dairy, and moderation sugar

10% of diet from fat Exercise for at least 30 minutes 5X a week or 60 minutes 3X a week Eat smaller meals

Eat all beans, legumes, fruits, Manage stress grains, vegetables through yoga and you need to feel meditation satiated

Pros Cons

• Obtain recommended • Low in fat- should not be amount of fruits and followed long term vegetables • Restricts nuts and seeds • Low sodium meals high in omega 3- fatty acids • Low acid and high mineral diet helps • Meals low in B12 and prevent osteoporosis Iron

• Regular exercise encouraged Other Diets

• Sugar Busters • LEARN diet – Low CHO diet – Focuses on: – Emphasizes low GI CHO • Lifestyle, Exercise, Attitudes, Relationships, – 30% CHO, 30% pro, 40% and Nutrition fat – Includes: – Restricts many foods and • 55-60% CHO anything that includes • 10% or less from sat. fat sugar. • Dec caloric intake • Exercise • Behavior modification Dietary Intake of Premenopausal Women for One Year on dif. Diets

Ornish

LEARN Fiber (%) Saturated Fat (%) Fat (%) Zone Protein (%) CHO (%)

Atkins

0 10 20 30 40 50 60

Alhassen et al, 2007 Truth #6

They cannot be maintained Must be sustainable!!!!! Ranges of Weight Lost on Differing Diets Diets 12 month weight loss range (kg) Atkins 3.1-6.3 Ornish 1.3-3.8 LEARN 0.8-3.6 Zone 0.4-2.8

Atkins most favorable wt loss without increasing TG or LDL, However HDL decreased

Alhassan et al, 2007. Comparison of Weight Loss Diets

70 60 50 40 30 Total fat (%) 20 10 SFA (%) 0 PUFA (%) MUFA (%)

Zone = 2221 kcal (highest), 5586mg/d Na (highest) Atkins = 730 mg/d cholesterol (highest) South Beach (phase 1) = 1263 kcal (lowest) Allison et al, 2007 Ornish = 2 mg/d cholesterol (lowest) Program Costs 450

400

350

300

250 Additional Costs $ Food Cost 200 Membership Fee 150 Start-up Fee 100

Weight watchers homepage. Web site. Last accessed: 12/10/13 http://www.weightwatchers.com/index.aspx. Nutrisystem homepage. Web site. Last accessed: 12/10/13 http://www.nutrisystem.com/jsps_hmr/home/index.jsp. Jenny craig homepage. Web site. Last accessed: 12/10/13 http://www.jennycraig.comMedifast homepage. Web site. Last accessed: 12/10/13 http://www.medifast1.com/index.jsp. USDA. Web site. Last accessed 12/10/13 http://www.cnpp.usda.gov/ Why Quit? Difficulty 71%  40% of men & 50% of women reported early Inconvenience Frustration cessation 28% 71%

 Commercial programs had the Hunger highest rate of 54% early cessation!

Julia, C., Peneau, S., Andreeva, V., Mejean, C., Fezeu, L., Galan, P., & Hercberg, S. (2014). Weight-loss strategies used by the general population: How are they perceived? Plos One, 9(5), e97834.

Long-term weight-loss maintenance study • Researchers were able to follow up with 55% (VLEDs) and 80% (HEBDs) of individuals in structured weight-loss programs after 4 and 5 yrs Findings: Very-low energy diets (VLED) were associated with significantly greater wt loss maintenance than hypoenergetic balanced diets (HEBD) The average individual maintained a weight loss of >3kg and reduced weight of >3% of initial body weight 5yrs after completing structured weight loss programs,

Anderson, J., Konz, E., Frederich, R., & Wood, C. (2001). Long-term weight-loss maintenance: a meta-analysis of US studies. American Journal of Clinical Nutrition, 74, 579-584. Weight Reduction Over Time W 18 e 16 i g 14 h t 12 10 L VLED 8 o HEBD s 6 s 4 kg 2 0 1 2 3 4 5 Years # of VLED 298 1307 778 688 337 subjects HEBD 152 650 152 152 36

Anderson et al., 2001 Limitations to Weight Loss Study Results

• Compliance to assigned diet • Lack of assessment to – Variation in actual intake adherence of prescribed compared to prescribed diet intake • Unequal intensity of • Usu under report fat and intervention CHO, & over report pro (Hursting et al) – Dietary instructions vs. intervention programs • Attrition rate • Small sample sizes • Honesty among participants • Short duration • Body composition?? • Funding??

National Weight Control Registry

Recruits subjects who have been successful at maintaining their weight loss long-term Over 10,000 individuals are members Requirement to join : -Must have maintained at least a -30lb weight loss for one year or longer

Habits of NWCR members:  78% eat breakfast everyday 75% weigh themselves at least once a week 62% watch less than 10 hours of TV per week 90% exercise about 1 hr per day

http://www.nwcr.ws/Research/default.htm Most Common Diet Strategies for Weight Loss

100 90 80 70 60 Percent of 50 NWCR 40 members 30 20 10 0 Restrict certain foods Limit Quantities Count Calories

Wing, R., & Phelan, S. (2005). Long-term weight loss maintenance. American Journal of Clinical Nutrition, 82, 222S-225S. Truth

1. Consider the source 2. Sustainable portion control is key! 3. Be specific 4. Diets don’t work 5. We are eating toooo many carbs 6. Must be sustainable.

What has changed in the last 25 years

• Less willpower? • Macronutrient mix changed? – Atkins, Ornish, Zone • Genetic changed? • What has changed? – Portions bigger – Food is everywhere

Consumer Reports 2005. The dining environment has changed

• Change the dining environment not conscious behavior • To correct portions sizes – Go back to the plate, bowl and cup sizes 25 yrs ago – Buy smaller packages – Be aware of visual cues • To correct for food being every where – Keep food out of sight – Make food inconvenient – Track what you eat, write it down

Consumer Reports 2005.

Easy ways to get recommended intake of fruits and veggies a day

• Disguise taste (add to pasta, stews or pizza) • Stock up on less-perishable fruits and veggies • Don’t forget breakfast – i.e. Fruit to yogurt or veggies to scrambled eggs • Bag it and bring as a snack

Consumer Reports 2005. Thank You!