Plant Foods and Weight Management:
The Science Behind Energy Density
(provided by the AICR)
SUMMARY: Nutrition researchers are uncovering new evidence that plant
foods have a long-overlooked but surprisingly central role in managing
weight. The key, according to this new spate of research, is energy
density. Vegetables, fruits, whole grains and beans are high in water
and fiber, but comparatively low in energy – that is, in calories.
As a result, they promote a feeling of fullness without the hefty calorie
payload that accompany foods higher in fat. At the same time, they provide
the body with an array of vitamins, minerals and phytochemicals that
promote health and protect against chronic disease.
Research that has provided food for subjects conclusively shows that
diets high in unrefined carbohydrates promote weight loss. In trials
where subjects are merely advised to increase plant foods consumption,
marked differences in compliance and methodology make results more difficult
to interpret. Reviews of the current scientific literature on the subject
conclude that diets high in plants food are not a “magic bullet,”
but are an important part of any effort to lose or maintain weight,
particularly when they are combined with increased physical activity.
Consumers Beginning to Tire of Low-Carb Diets
According to a July 2004 consumer survey conducted by InsightExpress,
an online research firm, half of Americans who have tried low-carb diets
have given them up, and the number of people trying them for the first
time is shrinking. The August 26 issue of Forbes magazine profiled a
recently launched low-carb food store in Southern California now facing
deep debt because its inventory of “carb-free” products
is languishing on the shelves.
Many find low-carb eating to be too restrictive, or simply tire of
meals that revolve around the same high-fat, high-calorie foods.
New Research Puts Energy Density to Work
Before the low-carb craze began, people turned to plant foods to help
them manage weight: dinner salads, an extra helping of vegetables, or
a piece of fruit. It wasn’t until the 1980s that nutritional scientists
began to examine how plant foods could affect weight management efforts
under rigorous clinical conditions. They began by testing how diets
with different proportions of fat and carbohydrates affected two basic
factors that, in turn, determine how many calories an individual consumes.
During a meal: How long it takes for people to feel full and stop eating.
After a meal: How long it takes for people to feel hungry again.
Researchers theorized that diets high in fat, which is energy dense
(meaning that a small amount comes with a high caloric payload) would
be associated with weight gain. They suspected that diets high in carbohydrates
would not be associated with weight gain, because vegetables and whole
grains are energy dilute, meaning that most of the “bulk”
of these foods comes from water and fiber, and thus promote a feeling
of fullness without delivering as many calories.
Different researchers conducted clinical trials that provided food
for small groups of individuals over a relatively short time –
as long as 11 weeks1-8. The food looked and tasted the same, and subjects
were allowed to eat as much as they wished, but researchers had secretly
manipulated the food’s fat and complex carbohydrate content. Thus,
over the course of the trials, some groups ate diets that were higher
in fat while other groups ate diets higher in carbohydrates.
As predicted, the results of these trials consistently showed that
the subjects’ body weight increased on high-fat diets, and decreased
on high-carbohydrate diets. What these trials (and subsequent studies
that have asked subjects to rate how full they feel after eating different
foods)9,10 have found seems surprising: foods high in fat promote passive
overconsumption because they don’t “fill you up” as
effectively as foods higher in “complex” or unrefined carbohydrates.
There’s a common sense reason for this: the key thing that makes
people feel full and stop eating is the sheer volume of food consumed,
the researchers concluded. Simply put, it will take just as long for
you to feel full eating a meal that’s high in fat as it will for
you to feel full eating a meal that’s high in vegetables and whole
grains. The difference is, by the time you start to feel full eating
the high-fat meal, you will have consumed many more calories than you
would have if you ate a meal higher in unrefined carbohydrates.
This was an important finding, because it conclusively demonstrated
that differences in fat and complex carbohydrate proportions can have
a significant and measurable impact on total caloric intake. This simple
fact became the foundation of a new branch of nutritional science focusing
on energy density and weight management.
Energy Density Proves to be an Effective Clinical Tool . .
. .
Barbara J. Rolls is a researcher at the forefront of efforts to employ
energy density in a targeted way to help manage weight. She and her
colleagues at Pennsylvania State University have conducted many studies
to investigate how adding vegetables, fruit, whole grains and other
plant foods to a meal lowers its energy density. They have consistently
found that diets high in vegetables and fruits result in lower caloric
intake – without feelings of hunger. In one study, increasing
the amounts of fruits and vegetables in meals reduced subjects’
total calorie consumption by more than 400 calories per day.11
Researchers have also found that vegetables and fruits seem to have
the advantage after a meal, because the fiber and water in meals high
in plant foods helps keep hunger from returning. In a series of Swedish
studies, simply adding spinach, carrots, and other high-fiber vegetables
to a meal significantly lengthened the time it took for subjects to
feel hungry again. (It was necessary to add at least 200 grams –
or two standard servings – of these vegetables to be effective.)12-15
Two long-term clinical studies provided meals for small groups of overweight
subjects over the course of three weeks. At the end of the both trials,
during which they ate meals that were much higher in vegetables and
fruits and lower in fat than their habitual diet, subjects showed significant
weight loss – in one trial, an average of 17.2 pounds.16,17
...But One That Must Be Adapted to “Real World”
Situations
Lowering the energy density in the diet consistently leads to weight
loss in studies where food is provided to subjects. In studies where
subjects are merely advised to increase the amount of fruits and vegetables
in their meals, however, the strategy has produced promising –
but not yet consistent – results.18-29
There are several possible reasons for this. Complications arise because
of differences in study design and methodology. Some studies that advise
subjects to increase fruit and vegetable consumption explicitly tell
the subjects that weight loss is a goal. Others provide the same advice
in another context, such as heart health or changes in cholesterol levels;
in such studies, weight tends to remain constant or decline only slightly.26,27,29
Some studies combine advice to increase fruit and vegetable consumption
with advice to lower fat intake.22,25,28 Not all of the studies that
have investigated energy density ask subjects to rate their between-meal
hunger, or measure how full they feel immediately after a meal. Compiling
results that arise from such different methodologies and comparing them
in a meaningful way is difficult.
In addition, there are many pertinent factors that can be controlled
for in the clinic, but that become more pronounced in the “real
world.” Clinical trials measure how different kind of foods affect
the basic physiological aspects of hunger, but people eat what they
eat for many other reasons. There are emotional and psychological factors
that cannot be easily measured or controlled for, and these also serve
to cloud the scientific picture.
Scientific Reviews Assess the Current State of Research
One recent paper that reviewed the available evidence from 34 intervention
studies on the relationship between plant food consumption and weight
loss concluded that “fruits and vegetables may play an important
role in weight management.”30
Another recent review examined the role of overall diet and nutrition
in obesity prevention in a more comprehensive way. The authors of that
review, which was originally prepared for the World Health Organization,
examined over 200 studies, 70 of which were specifically related to
the role of dietary fat, dietary fiber (i.e., plant foods) and energy
density. They concluded that “evidence is convincing that a high
dietary [fiber] intake helps to protect against weight gain.”31
Research is ongoing, but one thing has clearly emerged from the current
scientific evidence: adding vegetables, fruits and other energy dilute
plant foods to the diet is one important component of a successful weight
management program.
Literature Cited
1. Duncan KH et al. The effects of high and low energy density diets
on satiety, energy intake and eating time of obese and nonobese subjects.
American Journal of Clinical Nutrition 1983;37(5):763-7.
2. Lissner L et al. Dietary fat and the regulation of energy intake
in human subjects. American Journal of Clinical Nutrition 1987;46(6):886-92.
3. Tremblay A et al. Impact of dietary fat content and fat oxidation
on energy intake in humans. American Journal of Clinical Nutrition 1989;49(5):799-805.
4. Tremblay A et al. Nutritional determinants of the increase in energy
intake associated with a high-fat diet. American Journal of Clinical
Nutrition 1991;53(5):1134-7
5. Kendall A et al. Weight loss on a low-fat diet: consequence of the
imprecision of the control of food intake in humans. American Journal
of Clinical Nutrition 1991;53(5):1124-9.
6. Thomas CD et al. Nutrient balance and energy expenditure during
ad libitum feeding of high-fat and high-carbohydrate diets in humans.
American Journal of Clinical Nutrition 1992;55(5):934-42.
7. Stubbs RJ et al. Covert manipulation of the ratio of dietary fat
to carbohydrate and energy density: effect of food intake and energy
balance in free-living men eating ad libitum. American Journal of Clinical
Nutrition 1995;62(2):330-7.
8. Stubbs RJ et al. Covert manipulation of dietary fat and energy density:
effect on substrate flux and food intake in men eating ad libitum. American
Journal of Clinical Nutrition 1995;62(2):316-29.
9. Holt S et al. A satiety index of common foods. European Journal
of Clinical Nutrition 1995;49:675-90.
10. Feinle C et al. Carbohydrate and satiety. Nutrition Reviews 2002;60:155-69.
11. Bell EA et al. Energy density of foods affect energy intake in
normal-weight women. American Journal of Clinical Nutrition 1998;67:412-20.
12. Gustafsson K et al. Effects of different vegetables in mixed meals
on glucose homeostasis and satiety. European Journal of Clinical Nutrition
1993;47:192-200.
13. Gustafsson K et al. Dose-response effects of boiled carrots and
effects of carrots in lactic acid in mixed meals on glycemic response
and satiety. European Journal of Clinical Nutrition 1994;48:386-96.
14. Gustafsson K et al. Satiety effects of spinach in mixed meals:
Comparison with other vegetables. International Journal of Food Science
and Nutrition 1995;46:327-334.
15. Gustafssson K et al. Influence of processing and cooking of carrots
in mixed meals on satiety, glucose and hormonal response. International
Journal of Food Science and Nutrition 1995;46:3-12.
16. Shintani TT et al. Obesity and cardiovascular risk intervention
through the ad libitum feeding of traditional Hawaiian diet. American
Journal of Clinical Nutrition 1991; 53”1647S-1651S.
17. Shintani TT et al. The Hawaii Diet: ad libitum high carbohydrate,
low fat multi-cultural diet for the reduction of chronic disease risk
factors: obesity, hypertension, hypercholesterolemia, and hyperglycemia.
Hawaii Medical Journal 2001;60:69-73.
18. Henderson et al. Feasibility of a randomized trial of a low-fat
diet for the prevention of breast cancer: dietary compliance in the
Women’s health Trial Vanguard Study. Prevention Medicine 1990;19:115-33.
19. Singh RB et al. Effect of fat-modified and fruit and vegetable
enriched diets on blood lipids in the Indian Diet Heart Study. American
Journal of Cardiology 1992;70:869-74.
20. Singh RB et al. Randomized controlled trial of cardioprotective
diet in patients with recent acute myocardial infarction: results of
one year follow up. British Medical Journal 1992;304:1015-19.
21. Bear JT. Improved plasma cholesterol levels in men after a nutrition
education program at the worksite. Journal of the American Dietetic
Association 1993;93:658-663.
22. Gambera PJ et al. Use of the Food Guide Pyramid and US Dietary
Guidelines to improve dietary intake and reduce cardiovascular risk
in active-duty Air Force members. Journal of the American Dietetic Association
1995;95:1268-73.
23. Zino S et al. Randomized controlled trial of the effect of fruit
and vegetable consumption on plasma concentrations of lipids and antioxidants.
British Medical Journal 1997;314:1787-91.
24. Maskarinec G et al. Exploring the feasibility and effects of a
high fruit and vegetable diet in healthy women. Cancer Epidemiology
Biomarkers & Prevention 1999;8:919-24.
25. Smith-Warner SA et al. Increasing vegetable and fruit intake: randomized
intervention and monitoring in an at-risk population. Hawaii Medical
Journal 2001;60:69-73.
26. Lanza E et al. Implementation of a 4-y, high-fiber, high fruit
and vegetable low-fat dietary intervention: results of dietary changes
in the Polyp Prevention Trial. American Journal of Clinical Nutrition
2001;74:387-401.
27. Rock CL et al. Reduction in fat intake is not associated with weight
loss in most women after breast cancer diagnosis. Cancer 2001;91:25-34.
28. Singh RB et al. Effect of an Indo-Mediterranean diet on progression
of coronary artery disease in high risk patients (Indo-Mediterranean
Diet Heart Study): a randomized single-blind trial. Lancet 2002:360:1455-61.
29. Djuric Z et al. Methods to increase fruit and vegetable intake
with and without a decrease in fat intake: compliance and effects on
body weight in the Nutrition and Breast Health Study. Nutrition and
Cancer 2002;43:141-151.
30. Rolls et al. What can intervention studies tell us about the relationship
between fruit and vegetable consumption and weight management? Nutrition
Reviews 2004;62(1):1-17.
31. Swinburn BA et al. Diet, nutrition and the prevention of excess
weight gain and obesity. Public Health Nutrition 2004;7(1A):123-46.
|