Mayo Clinic Plan (Endorsed by Clinic)

Definition

Origins

Description

Function

Benefits

Precautions

Risks

Resources

Definition

The Mayo Clinic plan is the weight-management program created by the Mayo Clinic, a respected medical facility headquartered in Rochester, Minnesota. Unlike the fad diet erroneously bearing the clinic’s name, the actual Mayo plan concentrates on longterm health rather than a quick weight loss. While the Mayo Clinic fad diet is a temporary program that promises the dieter will shed 10 pounds (4.5 kilograms) in about two weeks, people following the 12-week Mayo Clinic Healthy Weight plan generally lose 1 to 2 pounds (0.45 to 0.90 kilograms) per week. The diet based on the clinic’s Healthy Weight Pyramid allows unlimited consumption of fruits and vegetables. Exercise is also prescribed.

Origins

The Mayo Clinic Healthy Weight Program was created by an organization with a long history of healthcare and research. The Mayo Clinic grew out of the medical practice of British doctor William Wor-rall Mayo and his sons, William James Mayo and Charles Horace Mayo. William W. Mayo came to the United States in 1846 and opened his first Minnesota medical practice in 1859. During the Civil War, he served as an examining surgeon for the Union Army. That work took him to Rochester, where he moved his family in 1864. Son William was 3 years old; Charles was born in 1865. Their father opened a medical clinic in Rochester that flourished. The brothers later practiced medicine with their father.

William W. Mayo died in 1911 at the age of 91, and his sons carried on the Mayo Clinic’s medical and research programs. The clinic researched diabetes during the 1920s. In the following decade, clinical studies included the investigation of new long-acting insulins. The Mayo Clinic General Clinical Research Center’s research after World War II included the 1950s studies of the use of low-cholesterol diets to reduce serum cholesterol.

The center’s obesity research during the 1990s demonstrated that a person’s body shape affected the risk for conditions like diabetes and heart attacks. The clinic defined the body types in terms of familiar shapes. The person with the majority of the body fat stored around the waist had an apple shape. The pear-shaped person’s fat was stored lower in areas such as the hips and thighs. Research showed that the apple shape, with fat in the abdominal area, raised the risk of health problems.

Mayo Clinic diet

Physical activity: Aim for 30 to 60 minutes of moderately intense physical activity most days of the week

Based on the Mayo Clinic diet pyramid. (Illustration by GGS Information Services/Thomson Gale.)

Clinical research also revealed that fidgeting, movements such as shifting in a chair, burned calories. The process was labeled ‘‘non-exercise activity thermogenesis.’’

The Mayo Clinic in November of 2000 unveiled the first food pyramid targeted at people trying to lose weight and keep the pounds off. The Mayo Clinic Healthy Weight Pyramid was based on scientific principles and research at the clinic, as well as at Pennsylvania State University and the University of Alabama at Birmingham.

The universities studied the effect of low-energy-dense foods on weight loss. Energy density is related to the calories in food. Low-energy-dense foods have a small amount of calories in a large amount of a food such as a fruit or vegetable. High-energy-dense foods like a candy bar have a large number of calories in a small amount of food.

The universities’ research demonstrated that people on low-energy dense food diets lost weight and kept the pounds off. Pennsylvania State University’s

KEY TERMS

Body Mass Index— Also known as BMI, the index determines whether a person is at a healthy weight, underweight, overweight, or obese. The BMI can be calculated by converting the person’s height into inches. That amount is multiplied by itself and then divided by the person’s weight. That number is then multiplied by 703. The metric formula for the BMI is the weight in kilograms divided by the square of height in meters

Calorie— The nutritional term for a kilocalorie, the unit of energy needed to raise the temperature of one liter of water by one degree centigrade at sea level. A nutritional calorie equals 1,000 calories.

Carbohydrate— A nutrient that the body uses as an energy source. A carbohydrate provide 4 calories of energy per gram.

Cholesterol— A fatty substance found each cell of the human body and in animal foods.

Fat— A nutrient that the body uses as an energy source. Fats produce 9 calories per gram.

Fiber— A complex carbohydrate not digested by the human body. Plants are the source of fiber.

Morbidly obese— Also known as extremely obese, the condition of someone with a BMI of more than 40.

Obese— A person with a high amount of body fat; someone with a Body Mass Index of 30 or higher.

Overweight— A person is too heavy for his or her height; someone with a Body Mass Index of from 25 to 30.

Protein— A nutrient that the body uses as an energy source. Proteins produce 4 calories per gram.

Serum cholesterol— Cholesterol that travels in the blood.

Thermogenesis— The generation of heat in the body.

research indicated that satiety, the sense of feeling full was connected to the volume and weight of food consumed. A person starting a low-energy-dense diet didn’t have to eat less food in terms of the amount consumed. However, the type of food was changed, with high-energy foods restricted and the addition of more low-energy-dense foods. The person ate the same volume of food, but consumed fewer calories.

In addition the dieter would experience a sense of fullness earlier because low-energy-dense food frequently had high fiber and water contents. Those foods took longer to digest, causing satiety after the consumption of fewer calories.

Furthermore, the University of Alabama pioneered the use of an unlimited allowance of whole vegetables and fruits in diets. It proved a successful method for losing weight and not gaining it back.

The Mayo Clinic drew on that research and created the Health Weight Pyramid and the clinic’s weight-loss program. The Mayo Clinic Healthy Weight Program is a low-calorie, plant-based diet. The emphasis is on the low-energy dense -foods in each food group. There is no limit on the amount of fresh fruits and vegetables allowed. Other low-energy dense-foods include whole-grain carbohydrates like pasta, brown rice, and baked potatoes.

Information about the Mayo Clinic Healthy Weight Program was available in the spring of 2007 on the Mayo Clinic website in the section titled ‘‘Mayo Clinic Diet: A weight-loss program for life.’’ The 12-week program was also detailed in the 2005 book Mayo Clinic Healthy Weight for EveryBody.

The other Mayo Clinic diet

During the 1940s, the dietitians at the Mayo Clinic began receiving questions from the public about the popular diet falsely attributed to the medical facility. The clinic had no connection to the fad weight-loss plan, and the origin of the Mayo Clinic fad diet was not known. The popular diet required the consumption of a half-grapefruit at each meal. Breakfast sometimes included two slices of bacon, and dieters ate meat during other meals. Missing from the weight-loss plan were other fruits, breads, and some vegetables. Since the 1940s, the Mayo Clinic has received calls about the fad diet. Most people inquire about it in the spring, according to a statement on the clinic web site in 2007.

Description

The four cornerstones of the Mayo Clinic Healthy Weight Program are the Healthy Weight Pyramid, physical activity, setting goals, and motivation. Dieters use the pyramid to plan menus rich in healthy foods such as fruits and vegetables. The pyramid calls for moderate amounts of other foods. Physical activity should be increased, with the ultimate goal of a person doing moderate physical activity for 30 to 60 minutes each day for most days of the week.

Goal-setting is based on actions taken rather than pounds lost. Goals such as increasing the amount of fruit consumed or exercise performed could be set and tracked on a weekly and monthly basis. Motivation provides the incentive to start a program that is essentially a lifetime plan.

The Healthy Weight Pyramid

The Mayo Clinic Healthy Weight Pyramid is a nutrition guide that focuses on low-energy-dense foods. The clinic defined energy density as the process of feeling full while eating fewer calories. Low-energy-dense foods like fruits and vegetables provide a small number of calories in a large amount of food. Foods with a high-energy density have a large number of calories in a small amount of food. These foods like desserts and processed foods often contain large amounts of sugar.

The pyramid shows food groups in terms of amounts that should be consumed. At the bottom of the triangle are low-energy-dense foods; at the peak are high-energy dense sweets. The Mayo Clinic Healthy Weight Pyramid consists of five levels:

• Level 1 is comprised of unlimited amounts of vegetables and fruits. The dieter should consume at least four servings of vegetables and the same amount of fruit. A vegetable serving is 25 calories, which is 2 cups (453.6 grams) of shredded lettuce, 1 cup (226.8 grams) of whole mushrooms, or 10 small radishes. A fruit serving is 60 calories, which is one small banana, half of a large grapefruit, or about 12 grapes.
• Level 2 includes carbohydrates such as whole grains including pasta, bread, rice and cereals. A carbohydrate serving is 70 calories. One serving equals a slice of bread, one half-cup (113.4 grams) of whole-grain pasta, or 2 cups (453.6 grams) of popcorn.
• Level 3 consists of protein and dairy. This category includes plant-based food such as beans, fish, lean meat, and low-fat dairy products. A serving is 110 calories, and one serving. That is 1/3 cup (75.6 grams) of beans, 3 ounces (85 grams) offish, 2 and one-half ounces (70.9 grams) of chicken, 1 cup (0.24 liters) of 2% milk, 2 ounces (56.7 grams) of 1ow-fat cheddar cheese, or one half cup (113.4 grams) of fat-free ice cream.
• Level 4 consists of fats such as heart-healthy olive oil, nuts, canola oil, and avocados. One serving of fat is 45 calories. That is 1 teaspoon (4.9 milliliters) of oil, four walnut halves, 1/6 avocado, or 3 tablespoons (44.3 milliliters) of fat-free cream cheese.
• Level 5 is the sweets category. It includes candy and processed sweets. The daily allowance at this level is up to 75 calories. This amounts to one small slice of angel food cake, one half cup (113.4 grams) of gelatin dessert, or 1 tablespoon (14.8 milliliters) of honey.
• Physical activity is at the center of the pyramid. The placement represents the central role of regular physical activity.

SERVING RECOMMENDATIONS. The Mayo Clinic plan based most recommended food pyramid serving portions on daily calorie allowances. For the person trying to lose weight, the medically accepted calorie allowance is generally 1,200 calories per day for women and 1,400 calories for men. A diet of less than 1,200 calories per day could deprive a person of nutrients like calcium, iron, and protein. Because of that, diets of less than 1,200 calories should be medically supervised.

The Mayo Clinic program starts with a 1,200-calorie allowance, with higher amounts based on a person’s weight. In addition, people who feel too hungry at one level or experience an extremely rapid weight gain are advised to follow the recommendations for the next level. In addition, the daily sweets allowance of 75 calories can be saved up so a treat with more calories is consumed on one day. However, the dieter must remember to budget the sweets in order to have a total weekly consumption of 525 calories.

The calorie allowances and serving recommendations from the Healthy Weight Pyramid are:

• 1,200 calories for women weighing 250 pounds (113.4 kilograms) or less. This consists of four or more servings of vegetables, three or more servings of fruit, four carbohydrate servings, three servings from the protein/dairy group, and three fats. A maximum of 75 calories of sweets may be consumed.
• 1,400 calories for men weighing 250 pounds (113.4 kilograms) or less and women weighing from 251 to 300 pounds (113.9 to 136.1 kilograms). The allowance is four or more servings of vegetables, four or more fruit servings, five servings of carbohydrates, four protein/dairy servings, and threes servings of fat. Up to 75 calories worth of sweets is allowed.
• 1,600 calories for men weighing from 251 to 300 pounds (113.9 to 136.1 kilograms) and women weighing 301 pounds (136.5 kilograms) or more. The allowance is five or more servings of vegetables, five or more fruit servings, six servings of carbohydrates, five protein/dairy servings, and three servings of fat. The sweets allowance is 75 calories.
• The 2,000-calorie allowance is a maintenance level or could be used while dieting. It consists of five or more vegetable servings, five or more servings of fruit, eight carbohydrate servings, seven protein/dairy servings, and five fat servings. Up to 75 calories worth of sweets is allowed.

Physical activity

Physical activity is a key element of the Mayo Clinic Healthy Weight Program. The activity could be exercises like walking and swimming or actions involving movement such as gardening and house-cleaning. Physical activity burns calories, which aids in weight loss. Even fidgeting is helpful in shedding pounds. Mayo Clinic studies indicated that the people who gained the least weight were those who fidgeted, moving around and doing activities like wiggling.

The goal of the Mayo Clinic program is for a person to do a moderately physical activity for 30 to 60 minutes on most days of the week. Moderately physical activities range from walking briskly to being constantly in motion while doing yard work. This type of exercise raises heart and breathing rates, according to the Mayo Clinic. The person may sweat lightly.

The calories burned during an hour of walking at a moderate intensity range from 250 to 340. The range is based on the person’s weight and fitness level, according to the clinic. Gardening for an hour would burn 272 calories for someone who weighing 150 pounds (68 kilograms). In addition, a fidgety person could burn 350 calories a day. That was the conclusion of a 2005 Mayo Clinic study of the movements of 10 obese people and 10 thin subjects. The obese people sat 2 one half hours more than the thin people; they burned 350 fewer calories as a result.

The clinic advises people to begin an exercise program gradually so that their muscles and joints can adapt. An inactive person may need to exercise five to 10 minutes per day and then work up to a longer exercise session. Walking is a popular exercise, and the book Mayo Clinic Healthy Weight for EveryBody features a 12-week walking program. There is also information about a range of physical activities.

Goal setting

While losing a specific amount of weight is the ultimate goal, the Mayo Clinic plan calls for setting gorals related to activities instead of pounds shed. Objectives should be specific, measurable and realistic such as increasing the servings of vegetables consumed or the distance walked. Weight-loss activity could be entered daily in a food and activity diary. The Mayo Clinic book has a daily food and activity record that could be copied and used to track progress on weekly and monthly goals.

Motivation

Motivation is the incentive that helps a person begin the Healthy Weight Program and continue to follow the plan for life. The Mayo Clinic book contains strategies for each of the 12 weeks of the program. These include avoiding treats at work by going for a short walk at break time. Other methods of motivation include concentrating on the positive aspects of weight loss and exercising with a friend or relative.

Maintenance

Once a goal weight is reached, the dieter’s challenge is to avoid gaining back the pounds lost. The Mayo Clinic plan recommends that the person continue exercising regularly and use the Healthy Food Pyramid for meal planning. The Mayo Clinic set the average daily calorie allowances at:

• 2,000 for the average adult.
• 2,200 for older children, teenage girls, most men, and active women.
• 2,400 for teenage boys and active men.

Function

The Mayo Clinic Healthy Weight Program was designed to produce a gradual weight loss through diet and exercise. The Healthy Weight Pyramid focuses on the consumption of foods with low-energy densities, foods that are generally low in calories. High-fiber foods such as fruits, vegetables, baked potatoes, and whole-grain products contain volume that causes a person to feel full. Also contributing to the sense of fullness is the fact that foods with fiber take longer to digest. Since the weight-loss plan places no limit on the amount of fruits and vegetables consumed, people satisfy hunger cravings with lower calorie-foods.

The Mayo Clinic program also emphasizes physical activity. The combination of regular exercise and nutritional eating could reduce the risk of conditions like diabetes, heart disease, and strokes.

Weight loss is just one aspect of the Mayo Clinic plan. The Healthy Weight Program also provides guidance about how to recognize and modify behaviors such as overeating to relieve stress. The program goal is for the dieter to make permanent changes in order to maintain a healthy weight.

Benefits

The benefits of the Mayo Clinic Healthy Weight Program are illustrated by the tile of the book, Mayo Clinic Healthy Weight for EveryBody.The program shows people how to use the Healthy Weight Pyramid and exercise in order to achieve a lifetime of healthy living. People who follow the plan gradually lose weight. Once a dieter reaches his or her goal weight, that person follows the plan to avoid gaining back those extra pounds.

The plan described in the Mayo Clinic book could be used to create a self-directed weight-loss program. By following the 12-week plan, the dieter learns about nutrition, portion control, and the importance of physical activity. Quizzes in the weekly units allow the dieter to understand issues such as eating habits.

Furthermore, direction is provided through weekly shopping lists and information about topics such as planning an effective and enjoyable exercise program. There are also tips from dietitians and recipes based on the Healthy Weight Pyramid.

Precautions

The Mayo Clinic Healthy Weight Program does not pose an overall risk to people. However, some people may need to take their health conditions into account when making food choices. People with those conditions or those who take some medications need to make those food choices even if they don’t follow the diet.

For example, pregnant women should not eat more than 12 ounces (0.34 ounces) of fish per week. Diabetics should monitor their blood sugar while following the program, and people with other conditions like food allergies should make adjustments when planning their menus. In addition, some fruits should be avoided by people taking certain medications. Grapefruit products, tangelos, and Spanish oranges should not be consumed by people using some anti-depressants, anti-seizure medications, tran-quilizers, immunosuppressant drugs and the pain relief drug Methadone. In addition, those citrus fruits should be avoided by people taking some medications to treat high blood pressure, HIV, high cholesterol, arrhythmia (abnormal heart rhythm), and erectile dysfunction.

People who aren’t sure if a health condition or medication will be affected by a food on the Mayo plan should discuss these concerns with their doctors. Healthcare professionals should also be consulted about what type of exercise is appropriate.

Risks

There are no known risks for people who follow the Mayo Clinic Healthy Weight Program. However, people with questions about health conditions or drug interactions are advised to consult their physicians before starting any weight loss program.

QUESTIONS TO ASK YOUR DOCTOR

• Would any health condition prevent me from starting the Mayo Clinic Healthy Weight Program?
• How much weight should I lose?
• Should I avoid certain foods because of medications I’m taking or because of a health condition?
• What is the minimum amount of calories that I should eat each day to lose weight?
• Am I physically able to begin an exercise program?
• What is the best type of exercise for me?
• How long should I do this exercise?
• How many times a week should I exercise?
• Are there any instructions I need to prevent injuries?

Research and general acceptance

Research

The Mayo Clinic Healthy Weight Program is the result of research by the clinic, the University of Alabama, and Pennsylvania State University. The clinic’s Healthy Weight Pyramid is listed on the United States Department of Agriculture’s list of sources of reliable weight loss information. In addition, the federal Dietary Guidelines for Americans 2005 defined a healthy eating plan as one that:

• Emphasizes fruits, vegetables, whole grains, and fat free or low-fat milk and milk products.
• Includes lean meats, poultry, fish, beans, eggs, and nuts.
• Is low in saturated fats, trans fats, cholesterol, salt, and added sugars.

Both the Mayo Clinic and the federal guidelines recommended that people consume a variety of foods within each group. The USDA document is updated every five years, and the 2005 edition focused more on weight control than previous versions. The guidelines, like the Mayo Clinic program, contained food-serving recommendations for calorie levels ranging from 1,000 to 2,000 per day. While the Mayo program allowed unlimited fruits and vegetables, the federal plan designated serving amounts. The USDA also recommended a restriction on sweets and 30 to 60 minutes of moderate physical activity most days of the week.

The American Heart Association also recommended a half-hour to an hour of moderate physical activity on most days. Furthermore, the heart association’s guidelines for weight loss are calorie allowances of 1,200 per day for women and 1,500 for men. This would produce a loss of one to two pounds per week. The association said that a weight loss program should include nutrition education so that people ‘‘embrace a lifetime of healthy eating habits.’’ Those recommendations paralleled those of the Mayo Clinic Healthy Weight Program.

General acceptance

The Mayo Clinic plan, with its emphasis on fruits and vegetables-, had not achieved the popularity of the Mayo Clinic fad diet as of the spring of 2007. Just one-fourth of American adults ate five or more servings of fruits and vegetables each day in 2005, according to ‘‘Physical Activity and Good Nutrition: Essential Elements to Prevent Chronic Diseases and Obesity At A Glance 2007,’’ a report by the Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion. The report also noted that 24% of adults were not physically active during their free time. In addition, more than 50% of adults did not do enough activity to gain health benefits from their efforts.

Some Americans have embraced parts of the Mayo Clinic plan, according to the 13 favorable customer reviews of Mayo Clinic Healthy Weight for EveryBody on the Amazon website in April of 2007. There were no negative reviews.

J.C. from Centennial, Colorado wrote a doctor recommended gastric bypass because of the reviewer’s excess weight. J.C. followed the Mayo plan, felt full and ‘‘wasn’t tempted to wander’’ from it. J.C. ‘s weight loss on the Mayo program led the doctor to report that the reviewer was in ‘‘very good health.’’

Resources

BOOKS

Hensrud, Donald (ed.) Mayo Clinic Healthy Weight for EveryBody. Mayo Clinic, 2005.

ORGANIZATIONS

American Dietetic Association, 120 South Riverside Plaza, Suite 2000, Chicago, IL 60606. (800) 877-1600. <http://eatright.org>.

American Heart Association National Center, 7272 Greenville Ave., Dallas, TX 75231. (800) 242-8721. <http://www.americanheart.org.>.

Mayo Clinic, 200 First St. S.W.,Rochester, MN 55905. (507) 284-2511. <http://www.mayoclinic.com>

OTHER

Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion. Physical Activity and Good Nutrition: Essential Elements to Prevent Chronic Diseases and Obesity At A Glance 2007. <http://www.cdc.gov/nccdphp/publica-tions/aag/dnpa.htm> (April 9, 2007).

Food and Nutrition Information Center National Agricultural Library/USDAWeight Control and Obesity Resource List for Consumers <http://www.nal.usda.gov/fnic/pubs/bibs/topics/weight/consumer.html> (April 11, 2007).

Mayo Clinic. Mayo Clinic Diet: A weight-loss program for life (2006). <http://www.mayoclinic.com/health/mayo-clinic-diet/WT00016> (April 7, 2007).

Rolls, Barbara, Ph.D. ‘‘Energy Density and Nutrition in Weight Control Management.’’ Permanente Journal-Spring 2003.<http://xnet.kp.org/permanentejournal/spring03/energy.html> (April 11, 2007).

Neighmond, Patricia. Wiggle While You Work: Fidgeting May Fight Fat.National Public Radio: All Things Considered, Jan. 27, 2005. < http://www.npr.org/> templates/story/story.php?storyId=4468682 (April 11, 2007.)

U.S. Department of Agriculture and the Department of Health and Human Services. Dietary Guidelines for Americans 2005 <http://www.health.gov/dietaryguidelines/dga2005/document> (April 9, 2007).

Liz Swain