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andrea levy




 
 
 
 

Post Thu, Apr 15 2021, 1:38 am
Final paper in lieu of a practicum...
Topic can be anything about nutrition. Please suggest topics!
Front runner right now is ketogenic diets as a nutrition intervention for autism spectrum disorders. Hard to find papers...
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professor




 
 
 
 

Post Thu, Apr 15 2021, 3:39 am
Do you want to write about gluten free dieting and the difference between healthy people vs people with celiac desease or carb free for diabetics vs healthy people and how each diet has to be specifically geared to the person keeping it?

Me: speaking about diets in the middle of the night
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shirachadasha




 
 
 
 

Post Thu, Apr 15 2021, 6:59 am
Can you survey people who keep kosher plus another restrictive diet (eg kosher and keto, kosher and vegan)?
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naomi2




 
 
 
 

Post Thu, Apr 15 2021, 7:42 am
Why don't you write about the diet/ lifestyle change you did for yourself. You have posted here about it a few times and I noticed the post sound very passionate. That is something you know well and care about and it will come through in your final paper. Just find a way to support it with scientific research.

If you want to write about diet affecting Autistic people, you will find alot more about a gluten free and casein free diet.
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andrea levy




 
 
 
 

Post Thu, Apr 15 2021, 9:18 am
professor wrote:
Do you want to write about gluten free dieting and the difference between healthy people vs people with celiac desease or carb free for diabetics vs healthy people and how each diet has to be specifically geared to the person keeping it?

Me: speaking about diets in the middle of the night


Interestingly my position is that nutrition is very individual ( although for some things, some foods work and others don’t. Like candy floss is that not compatible with diabetes and gluten is not compatible with celiac. I’m not sure what I’d hypothesize.
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andrea levy




 
 
 
 

Post Thu, Apr 15 2021, 9:23 am
naomi2 wrote:
Why don't you write about the diet/ lifestyle change you did for yourself. You have posted here about it a few times and I noticed the post sound very passionate. That is something you know well and care about and it will come through in your final paper. Just find a way to support it with scientific research.

If you want to write about diet affecting Autistic people, you will find alot more about a gluten free and casein free diet.


Thanks. Gluten and casein is where I started with my own son and it was a big fail, I now know because it wasn’t enough. I wish I’d kept better records with him, or I could have done a case study on the ketogenic diet. It’s still my front running topic....
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andrea levy




 
 
 
 

Post Thu, Apr 15 2021, 9:25 am
shirachadasha wrote:
Can you survey people who keep kosher plus another restrictive diet (eg kosher and keto, kosher and vegan)?


I’d love to do a survey but don’t believe I have the time to complete it. It’s due by end of may, and I’ve never designed a study before!
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EMEN




 
 
 
 

Post Thu, Apr 15 2021, 9:58 am
Similar to your original idea is ketogenic diet for epilepsy
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andrea levy




 
 
 
 

Post Thu, Apr 15 2021, 10:34 am
EMEN wrote:
Similar to your original idea is ketogenic diet for epilepsy


Epilepsy is where the whole neuro thing started. I thought about this but it’s hard to find current research since it stopped being a primary clinical treatment a hundred years ago. Thanks for helping!
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andrea levy




 
 
 
 

Post Thu, Apr 15 2021, 10:35 am
naomi2 wrote:
Why don't you write about the diet/ lifestyle change you did for yourself. You have posted here about it a few times and I noticed the post sound very passionate. That is something you know well and care about and it will come through in your final paper. Just find a way to support it with scientific research.

If you want to write about diet affecting Autistic people, you will find alot more about a gluten free and casein free diet.


I think maybe if I’d kept better records, I could have done a case study, but this is too late now...

Also I’m of the opinion that gluten and casein does not go far enough. Also that casein may or may not affect people. I think they’re more likely to be allergic to lactose than casein.
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shirachadasha




 
 
 
 

Post Mon, Jun 28 2021, 12:18 am
What topic did you choose in the end? How did it go?
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andrea levy




 
 
 
 

Post Mon, Jun 28 2021, 1:00 am
shirachadasha wrote:
What topic did you choose in the end? How did it go?


I forgot I’d posted this. In the end, I chose weight loss maintenance. Sadly, the state of lockdown in Ontario during the entire time of writing meant that many of us took the article option and tbe Prof, stuck at home with four little kids, did not have enough time to really give us guidance like he could have had the kids at school or daycare.

I wrote my paper after reading about 70 papers and I Cited 35, some of them multiple times. I feel like my dive into the topic isn’t completely over, and that at some point, maybe in future studies, I’ll tease it out.

In the mean time, I’m starting to volunteer with a Canadian organization called Obesity Matters that focuses on fighting stigma and advocating for health that is not size specific. I submitted my paper to them and I guess it’s possible it’ll actually get published, although not in a journal.

I’m not sure I could post it here, really. It’s long if you include all the references. If you want to read it, pm me your email and I’ll send it. It’s maybe not brilliant but I did work incredibly hard and got an excellent grade. Considering my undergrad background as an English Lit major, I felt like it was a huge win.
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andrea levy




 
 
 
 

Post Mon, Jun 28 2021, 1:04 am
professor wrote:
Do you want to write about gluten free dieting and the difference between healthy people vs people with celiac desease or carb free for diabetics vs healthy people and how each diet has to be specifically geared to the person keeping it?

Me: speaking about diets in the middle of the night


One thing I definitely learned this year is that whatever the ‘recommended’ diets are, it’s very individual and that really, no one should be prescribing nutrition as a one size fits all plan.

What works for each person is best figured out by each person.
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andrea levy




 
 
 
 

Post Mon, Jun 28 2021, 1:22 am
1

Is Weight-loss a lost cause?
PRAC9400- 01 Niagara College
May 15, 2021
Niagara College, May 15/21
By Andrea Levy.

“No one is getting out alive.” Nanea Hoffman

Abstract
Weight-loss in obese people may be achieved through a variety of adjustments to energy balance, hormonal balance and behavioural activities. There is a plethora of research about weight-loss but a dearth of evidence focusing on maintaining weight loss and preventing regain.
There is significant evidence that when weight loss occurs in obese subjects, adaptations occur that prevent barriers to long term maintenance and often result in metabolic and psychological damage.
The purpose of this paper is to review the literature to define the factors that are most likely to influence weight-loss maintenance and to propose long term behaviours that can affect the success of such endeavours, including prevention of weight gain, which may be more easily effected than weight-loss.
Background
Obesity is a complicated, multifactorial chronic medical condition that has become a significant burden on public health vis-a-vis morbidity, mortality and cost of health care. (1, 2, 3, 4,) Obesity is commonly defined as excess body fat for height but obesity can also manifest metabolically in averaged sized people. (2, 5)
Obesity is defined by the World Health Organization (6) as abnormal or excessive fat accumulation that presents a risk to health. The Body Mass Index (BMI), calculated by weight in kg divided by the square of height in m. This is a relatively simple way to calculate obesity however BMI cannot distinguish between lean and fat mass, or adipose tissue distribution and is considered a measure of low sensitivity with great inter-individual variability. (7, 8) BMI does not account for metabolic disorder, visceral and ectopic fat stores, gender, or differences by ethnic group or age. (7, 8) Other measures of obesity include waist circumference, calculation of waist to hip ratios, skinfold thickness and techniques such as ultrasound, bioelectrical impedance, Dexascan and ultrasound. Each of these measures have strengths and weaknesses. (7)
In 2019, Dietz and Gallagher (9) proposed a standard of care for obesity in adults including a minimum standard of care that applies to primary and community based care. The working group tasked with completion of this standard did not reach consensus on including quality of life measurements, which might guide practitioners to interventions that were appropriate to the state of mind of the patient. The proposed standard suggests that obesity should be treated as a chronic disease, with provision of appropriate medical care regardless of their point of entry to the medical system, sensitivity to the environment of the patient, and with providers understanding how to have the conversation about weight and management of obesity as a lifelong disease. They proposed a multidisciplinary team model of obesity management that would minimize discrimination against the obese and include changes in behaviours, health outcomes and size for the patient along with the need to monitor for weight regain. An important concept was ensuring that the benefit of treatment outweighs the potential risks and costs of the treatment, especially when there is evidence that the treatment could be harmful. (9)
In people with obesity, there is an increase in risk of chronic disease, including disability, depression, type 2 diabetes, cardiovascular disease, certain cancers and overall mortality. (2, 10, 11) Weight Loss
Weight-loss recommendations are commonly advised as 5-10% of body weight to improve health outcomes. (10, 12, 13, 14, 15, 16, 17) Interventions for weight loss and maintenance have included: fasting (with or without meal replacement product,) low fat, low calorie, low carbohydrate, varying macros, exercise and pharmacology, (18, 19, 20) The DIETFITS study (21) a randomized clinical trial, concluded that weight-loss between participants utilizing either a healthy low fat or healthy low carb diet was not significantly different in weight loss or baseline insulin secretion and that Resting Energy Expenditure(REE) was not significantly different between groups but decreased significantly in both groups.
Energy flux (calories in/out) is the accepted process for weight changes, indicating that weight loss or gain is caused by a caloric deficit (loss) or surplus (gain.) (18) It is unclear how to account for numerous factors that drive eating behaviour and dictate caloric intake. (18, 19) The range of inter-individual responses to energy deficit make it difficult to predict treatment response and the variability indicates that inter-individual differences may be the biological norm, rather than an abnormality. (19)
Dieting Adaptations
Dieting induces a number of physiological and behavioral adaptations that collectively result in


Last edited by andrea levy on Mon, Jun 28 2021, 1:34 am; edited 1 time in total
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andrea levy




 
 
 
 

Post Mon, Jun 28 2021, 1:26 am
an elevation of appetite and a suppression of energy expenditure (energy gap) defined as the desire to consume more energy than needed (17, 19, 22, 23) Among these adaptations are an increase in the hormone ghrelin and decrements in anorexigenic hormones (which cause hunger), lower circulation of leptin, leptin resistance (resulting in lower satiety), lower Resting Metabolic Rate (RMR), decreased thermic effect of food, increased efficiency at work intensities (19, 22) and adaptive thermogenesis (18, 19) Hypothalamic neuronal activity, neuropeptide expression, and gut
peptide expression are thought to play a role in the increased hunger in response to weight loss. (19, 22)
The mismatch between appetite and metabolic requirements, establishes a strong and persistent biological pressure to regain lost weight (17, 19, 22, 23, 25) which can also be seen behaviourally and cognitively. (24) It is posited that homeostatic regulation of food intake occurs such that severe caloric energy restriction leading to weight loss results in a strong internal drive to eat. (19) Insulin and leptin are influential in this process by driving hunger and satiety. (22)
In 1984, Leibel and Hirsch reported lower total daily energy expenditure (TDEE) in post-obese people compared to never-obese individuals—which was 25% lower than predicted by metabolic body size. In 1995, they determined that obese subjects losing 10–20% of their body weight experienced a significant decrement in TDEE which could not be fully explained by the loss of respiring body mass. They reported a mean reduction in TDEE of 8 kcal/kg fat-free mass (FFM) per day in those obese subjects who lost at least 10% body weight. The decreases in TDEE reflect adaptive thermogenesis (AT,) the change in energy expenditure independent of changes in FFM and the composition of FFM. AT may persist long term. (27, 22)
Metabolic changes that result in lower energy expenditure would not contribute to weight regain
if there were a proportional decrease in food intake however, body composition and hormonal
changes occur with weight loss that are associated with increased rather than decreased appetite. (20)
The majority of these adaptive responses do not appear to resolve once weight has stabilized at the reduced body weight. (6) Data from preclinical models would suggest the converse, the collection of adaptive responses strengthen as time in the weight-reduced state increases. (17)
Maintainers and Re-gainers
Research has shown that typically, regardless of how weight is lost, that after 6 months, a large percentage of patients start to regain weight. There are gaps in the evidence about approaches to treat obesity resulting from the complicated nature of obesity as a chronic disease. (12)
A study of the National Weight control Registry (NCRW) (28) proposed that long-term weight loss be defined as intentionally losing 10% of body weight and then maintaining the loss for a year. (28) The perception of the general public is that “no one ever succeeds at long-term weight loss.” (29) A study of 100 obese individuals were studied by Stunkard and McLaren-Hume in 1959 and their research indicated that, 2 years after treatment, only 2% maintained a weight loss of 9.1 kg (20 lb.) or more. More recent research posits that as energy expenditure declines with weight loss, patients are predisposed to weight gain as a result of their weight loss. (12, 17, 30) leaving less than 20% of weight-losers to maintain their loss after a year. (13, 20, 22, 24, 29)
Maintenance is possible as illustrated by the National Weight Control Registry (NWCR.) The registry is limited in that it does not include all dieters, and is self-reported. (12, 22) The NCWR and the MedWeight Registry in Greece (maintainers and re-gainers) have some mutual findings. Among men, maintainers partake in greater physical activity and adhere strongly to a dietary pattern including less processed foods. (12, 22, 31) In women, maintainers eat more slowly and more often and ingest more protein relative to body mass. (22, 32)
Greaves (24) suggests that tension beyond the Energy Gap includes new behaviour patterns, failing to meet personal needs, as well as a feeling of ongoing struggle in both maintainers and re-gainers. In addition, tension is created by the replacement of obesogenic behaviours. These behaviours (some long-standing) must be replaced and many were strategies for regulating emotion, stress, relief of boredom, pleasure social or cultural engagement. (24)
In particular, the attitudes and behaviours of family and friends are thought to be particularly important, especially when the patient relies on them. (24)
In all of these studies, maintainers versus re-gainers could differ in a variety of genetic,
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andrea levy




 
 
 
 

Post Mon, Jun 28 2021, 1:28 am
epigenetic, psychological, and other factors. Nevertheless, these data provide evidence that maintenance of lost weight can and does occur in some individuals, even in the face of environmental pressures and well-recognized metabolic adaptations. (22)
Exercise- Much debated
The WHO guidelines recommend at least 150 min of moderate-intensity aerobic physical activity or 75 min of vigorous intensity physical activity per week and doubled for weight loss maintenance. (17) Physiological adaptations caused by dieting and resulting in energy gap, have often been hypothesized to be mitigated by exercise. Exercise as a strategy to improve obesity treatment or as a weight loss or maintenance strategy is unclear for the following reasons:
• Minimal evidence from randomized controlled trials (RCTs) (2) (17)
• Behavioral compensation in response to exercise as a result of energy gap and tension (17)
• Inter-individual variability including gender, genetics and environment in response to exercise (17)
• “It doesn’t matter, they won’t do it”. =/- 50% of adults who begin an exercise program drop out within the first 6 to 12 months (17)
While the efficacy of exercise as an essential part of weight loss maintenance is beyond the scope of this paper, it should be noted that in numerous studies show maintainers exercise regularly, however the amount of influence that has on their maintenance is unclear. Inclusion of regular physical activity may be part of the overall behavioural changes that maintainers make and not be directly responsible for energy flux. More research is needed. (17, 24, 28)
Metabolically Healthy Obesity as an Option
Weight regain has been associated with higher levels of depression, binge eating, dietary disinhibition and increases in hunger. (12, 22)
The increased risks of obesity are well documented in the literature and include an increased death risk by related conditions as well as years of potential life lost including quality of life. There is data to indicate that grade 1 obesity is not associated with increased mortality and that overweight is associated with lower all-cause mortality (33) Engin asserts that the main drivers of these deaths are endocrinological (44%) and cardiovascular diseases. (38%) Engin suggests metabolic health status has a close relationship to obesity related cancer. The mortality rate increases, not with the level of obesity but with the state of metabolic health. (33)
The Obesity Paradox was noted in several studies of patients admitted to intensive care units (ICU) and points out that hospital mortality rates increase in patients with lower BMI <18.5) and are lowest in obese patients with BMI 30-39.9. (33)
Weight calculated by BMI does not predict all risks of excess weight accurately. Metabolically healthy obesity (MHO) has been suggested as an achievable goal that might be easier to achieve than drastic weight loss. (34) There is no consensus among scientists and clinicians about what metabolic health looks like, however if the main drivers are endocrinological and cardiovascular, the hypothesis for metabolic health versus unhealthy obesity could focus on metabolic health and cardiovascular health, which are related but not the same. (34)
A definition of metabolic health could be defined as the absence of metabolic syndrome:
Triglyceride concentration equal to or higher than 1·7 mmol/L; HDL cholesterol concentration lower than 1·0 mmol/L in men, or 1·3 mmol/L in women, or lipid lowering medication use; blood pressure equal to or greater than 130/85 mm Hg, or antihypertensive medication use; or fasting glucose concentration equal to or higher than 5·6 mmol/L or self-reported diabetes. (34) If
a person has one or less of these indications, they could be classed as MHO.
Analysis does not show that metabolically healthy obesity is comparable to risk in metabolically healthy individuals of normal weight however their risk is considerably lower than those with metabolically unhealthy obesity. (34)
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andrea levy




 
 
 
 

Post Mon, Jun 28 2021, 1:28 am
Future Directions
In 2005, Hill and Wyatt (23, 35) suggest that research for strategies to maintain weight loss or prevent weight gain should be the focus in future research. They acknowledge that there are factors, either pre-existing or created by being obese, that make it more difficult to maintain a weight loss than to prevent weight gain prior to obesity. A significant part of weight loss maintenance is dictated by behaviour and the larger the energy gap, the more behaviour change is needed to prevent weight gain. This perspective could be that preventing weight gain initially requires the least amount of behaviour change. Maintenance of negative energy balance for weight loss is difficult to maintain with food restriction alone. This results in weight loss requiring the largest amount of behaviour change (23, 35)
Hill et al (23, 35) acknowledged that from an energy balance perspective (CICO) and taking into account the biological tendencies to oppose weight loss in energy balance, emphasizing prevention of weight gain, physical fitness though sustainable activity and research in healthy obesity is a health status that should be worked toward in the short term with a long term goal of sustainable weight loss
References
1) Upadhyay, J. Farr, O. Perakakis, N., Mantzoros C. (2017) Obesity as a Disease, Med. Clin N. Am.
2) Hruby, A., Hu, F. B. Hu (2015) The Epidemiology of Obesity: A Big Picture
Pharmacoeconomics
3) Nilsson, P. M., Korduner, J., & Magnusson, M. (2020). Metabolically Healthy Obesity (MHO)—New Research Directions for Personalised Medicine in Cardiovascular Prevention. Current Hypertension Reports
4) Foright, R. M., Presby, D. M., Sherk, V. D., Kahn, D., Checkley, L. A., Giles, E. D., MacLean, P. S. (2018). Is regular exercise an effective strategy for weight loss maintenance? Physiology & Behavior
5) St-Onge, M., Janssen, I., Heymsfield, S. B., (2004) Metabolic Syndrome in Normal- weight Americans Diabetes Care
6) World Health Organization. (2015) Obesity and overweight. Fact sheet N°311
7) Adab, P., Pallan, M., & Whincup, P. H. (2018). Is BMI the best measure of obesity? BMJ
8) Yu Chung Chooi, Cherlyn Ding, Faidon Magkos, (2018) The epidemiology of obesity. Ymeta (2018)
9) Dietz, William H.; Gallagher, Christine (2019). A Proposed Standard of Obesity Care for All Providers and Payers. Obesity
10) Häring, S. N., Hu, F. B., Schulze, M. B. (2010) Metabolically Healthy obesity: epidemiology, mechanisms, and clinical implications. Lancet Diabetes Endocrino 2013
11) Dombrowski, S.U., Knittle, K., Avenell, A., Araujo-Soares, V., Sniehotta, F.,( 2014)
BMJ
12) Varkevisser, R. D. M., van Stralen, M. M., Kroeze, W., Ket, J. C. F., & Steenhuis, I. H. M. (2018). Determinants of weight loss maintenance: a systematic review. Obesity Reviews
13) Wing, R. R., Lang, W., Wadden, T. A., Safford, M., Knowler, W. C., Bertoni, A. G. (2011). Benefits of Modest Weight Loss in Improving Cardiovascular Risk Factors in Overweight and Obese Individuals WithType 2 Diabetes. Diabetes Care
14) Thomas JG, Bond DS, Phelan S, Hill JO, Wing RR. Weight-loss maintenance for 10 years in the National Weight Control Registry. Am J Prev Med. 2014
15) Fruh, S. M. (2017). Obesity: Risk factors, complications, and strategies for sustainable long-term weight management Journal of the American Association of Nurse Practitioners
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andrea levy




 
 
 
 

Post Mon, Jun 28 2021, 1:29 am
16) Ramage S., Farmer, A., Apps Eccles K., and McCargar L. (2013) Healthy strategies for successful weight loss and weight maintenance: a systematic review. Applied Physiology, Nutrition, and Metabolism.
17) Foright, R. M., Presby, D. M., Sherk, V. D., Kahn, D., Checkley, L. A., Giles, E. D., MacLean, P. S. (2018). Is regular exercise an effective strategy for weight loss maintenance? Physiology & Behavior
18) Aragon, A. A., Schoenfeld B. J., Wildman, R., Kleiner, S., VanDusseldorp, T., Taylor, L., Earnest, C. P., Arciero, P. J., Wilborn, C., Kalman, D. S, Stout, J. R., Willoughby, D. S., Campbell, B., Arent, S. M., Bannock, L., Smith-Ryan, A. E., Antonio, J. (2017) International society of sports nutrition position stand: diets and body composition
19) Casanova, N., Beaulieu, K., Finlayson, G., & Hopkins, M. (2019). Metabolic adaptations during negative energy balance and their potential impact on appetite and food intake. Proceedings of the Nutrition Society
20) Maclean, P.S., Bergouignan, A., Cornier, M.A., Jackman, M.R. (2011) Biology’s response to dieting: The impetus for weight regain. Am. J. Physiol. Regul. Integr. Comp. Physiol.
21) Gardner CD, Trepanowski JF, Del Gobbo LC, et al. (2018)Effect of Low-Fat vs Low- Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion: The DIETFITS Randomized Clinical
Trial. JAMA.
22) Melby CL, Paris HL, Foright RM, Peth J. Attenuating the Biologic Drive for Weight Regain Following Weight Loss: Must What Goes Down Always Go Back Up? Nutrients. 2017
23) Hill, J. O., Wyatt, H. R., & Peters, J. C. (2012). Energy Balance and Obesity.
Circulation,
24) Greaves, C., Poltawski, L., Garside, R., & Briscoe, S. (2017). Understanding the challenge of weight loss maintenance: a systematic review and synthesis of qualitative research on weight loss maintenance. Health Psychology Review
25) Leibel RL, Hirsch J. Diminished energy requirements in reduced-obese patients. Metabolism. 1984
26) Leibel, Rudolph L.; Rosenbaum, Michael; Hirsch, Jules (1995). Changes in Energy Expenditure Resulting from Altered Body Weight NEJM
27) Fothergill E, Guo J, Howard L, Kerns JC, Knuth ND, Brychta R, Chen KY, Skarulis MC, Walter M, Walter PJ, Hall KD. (2016) Persistent metabolic adaptation 6 years after "The Biggest Loser"competition. Obesity
28) Thomas JG, Bond DS, Phelan S, Hill JO, Wing RR. (2014) Weight-loss maintenance for 10 years in the National Weight Control Registry. Am J Prev Med.
29) Rena R Wing, Suzanne Phelan, (2005) Long-term weight loss maintenance, The American Journal of Clinical Nutrition,
30) Ebbeling, C. B., Feldman, H. A., Klein, G. L., Wong, J. M. W., Bielak, L., Steltz, S. K., ... Ludwig, D. S. (2018). Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance: randomized trial. BMJ
31) et al.
32) AJ McLaren-Hume M The results of treatment for obesity Arch Int Med 1959
33) Engin, A. (2017). The Definition and Prevalence of Obesity and Metabolic Syndrome. Advances in Experimental Medicine and Biology Advances in Experimental Medicine and Biology
34) Norbert Stefan, Hans-Ulrich Häring,Matthias B Schulze, 2017 Metabolically healthy obesity: the low-hanging fruit in obesity treatment? The Lancet.com/diabetes-
endocrinology
35) Hill, J. O., Thompson, H., & Wyatt, H. (2005). Weight Maintenance: What’s Missing? Journal of the American Dietetic
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