lesson 5 Flashcards
What are the priorities for a balanced diet?
– Create energy deficit
– Avoid nutritional deficiencies
– Preserve lean mass (exercise+ sufficient protein)
– Promote long-term adherence (avoid hunger) -> no extreme restrictions Change behavioral and dietary habits for life
High-protein diets for weight loss - Results
Greater reduction in:
- Body weight
- Fat mass
- Serum triglycerides
Less reduction in fat-free mass
No difference in changes in: Total cholesterol, LDL-C, HDL-C, systolic and diastolic BP, fasting glucose and insulin
- Less reduction in REE
What are the 5A of obesity management for adults
ASK for permission to discuss weight and explore readiness
ASSESS obesity related risks and ‘root causes’ of obesity
ADVISE on health risks and treatment options
AGREE on health outcomes and behavioural goals
ASSIST in accessing appropriate resources and providers
What are the therapeutic objectives of weigth loss?
- Changes in eating behaviours- number ONE goal!!
- Weight Loss / weight stabilization
- Prevention of weight regain
- Reduction in risk factors (diabetes, hyperlipidemia, hypertension, …)
- Eligibility for surgery
- Psychosocial adjustment
What are the improvements of diabetes control through weight loss
Improved Glucose tolerance
Improved Insulin sensitivity
Decreased Need for glucose lowering medications
Cardiovascular benefits of weight loss
- Normalizes triglyceride levels
- Raises HDL cholesterol
- Lowers LDL cholesterol
- Improves CHD risk profile
- Reduces need for antihyperlipidemic medication
Benefits of weight loss on hypertension
Decreased Systolic blood pressure
Decreased Blood volume
Decreased Cardiac output
Decreased Sympathetic activity
Decreased Need for antihypertensive medication
Benefits of a 10 kg weight loss in terms of mortality
Decreased total mortality, diabetes-related mortality, obesity-related cancer deaths
Weight Loss Phase diet, physical activity and other recommendations
Diet
- Hypocaloric
- Nutrients adequate, balanced
Physical activity- should be promoted- for lean mass conservation especially
Behavior modification
Weight maintenance Phase diet, physical activity and other recommendations
Diet
- Isocaloric vs. the new weight
- Nutrients adequate, balanced P
hysical activity is important for LBM maintenance Behavior modification
Estimate Daily Energy Requirements and Intake calculation
TEE (kcal/d) = REE x activity factor (Low=1.3, Moderate= 1.5, high= 1.8)
or
TEE (kcal/d) from IOM equations
How to calculate how many calories to loose per day to achieve a certain fat loss per week What do we have to remember during this calculation?
1lb (454g) of adipose tissue is 87% fat= 395g fat= 3500kcal
To lose 3500 kcal per week = - 500 kcal per day however, there will also be protein and water loss, thus more than 1 pound may be lost with 500 kcal restriction
What is the weight loss approach when quite a bit of weight is to be lost?
could be step wise: loss -> stable -> loss -> stable decreases the risk of relapse
What should we aim for when setting a target weight?
Realistic weight goal and time to achieve it ex: if goal is loss of 10 kg at 0.5 kg/wk-> 20 weeks
- Aim to reach healthy BMI (upper range) or
- Aim for more modest weight loss (5-10%)
table of
PRO
CHO
Fat
Multivitamin and mineral supplement
to be consumed when consuming certain amount of calories
What are the DRIs that have to be met durign calory resticitve diet?
Meet DRIs: Na 1500 mg/d, K 4.7 g/d, Ca 1000 mg/d, Fe 8/18 mg/d, ≈2 L fluid
Which was the diet in term of fat and GI that resulted in no weigth regain?
Which resulted in the most regain?
High protein, low GI
Most: LP-HGI
A modest increase in __ content and modest reduction in _favored maintenance of body weight
A modest increase in protein content and modest reduction in GI index favored maintenance of body weight
Which gender is more likely to participate in a health-related study?
women
What are the habbits of successful weigth control
– Most continue low energy, low fat diet, minimal variation
– 78% eat breakfast
– 90% exercise on average 1 hour per day
– 75% weigh themselves once a week
– 62% watch less than 10 hours TV per week
Management of obesity – Key messages
- A modest weight loss of 5-10% is beneficial
- Weight maintenance and prevention of weight regain should be considered as long term (even life-long) goals
What are the protein distribution ranges for weight loss, normally and maintenance
normally 10-35%
25-30% during weight loss
15-20% for maintenance
What are the fat intake recommendation for weight loss
For some, better ≤ 30% total fat
• include good sources of essential fatty acids
• low intake of saturated and trans fatty acids
WHat do clients need to be educated on for weigth loss?
- Content of a healthy plate
- Normal portion sizes
- Read food labels
- Limit highly processed foods
- Be aware of food marketing
- Healthy eating habits
Physically inactivity __ with _ age
Physically inactivity increases with increasing age
What is the recommended diet for weight loss in terms of protein, fat and CHO
high-protein (25-30%) and moderate fat, 45-65% carbohydrates
What are the benefits of physical activity?
- reduces risk of premature mortality
- Modest enhancement in physical activity/fitness in previously sedentary individuals have been associated with large improvement in health status.
- small change in activity form being a low activity individual drastically decreases the number of death, however the improvement plateaus immediately after that
tips for weight loss
Eat plenty of vegetables and fruits, whole grain foods and protein foods. …
Limit highly processed foods. …
Make water your drink of choice.
Use food labels.
Be aware that food marketing can influence your choices.
What are the imrpovements cuased by strength training?
- imrpoved nerve function
- increases muscle size and bone mass
- improved strength and endurance
- imporved phsyical performance and funciton
How do healh benefits and finteness benefits related to physical activity
Fitness- continuosly increases with increased intenstiy
Health benefits- imporvement tapers of after a certain point
Benefits of excercise/fitness vs benefits of phsycially active lifestyle
Excercise/Fitness: Aerobic capacity, Muscular strength, Anaerobic threshold, Cardiac function
phsycially active lifestyle: Blood glucose, Insulin resistance ,Blood lipids, Blood pressure, Body composition
Canadian physcial activity guidelines
- accumulate at least 150 minutes of moderate- to vigorous-intensity aerobic physical activity per week, in bouts of 10 minutes or more.
- It is also beneficial to add muscle and bone strengthening activities using major muscle groups, at least 2 days per week.
- More physical activity provides greater health benefits.
moderate vs vigorous activity
moderate- sweat a little
vigorous- sweat a lot and be out of breath
physcial activity recommendations to prevent weigth gain
PA of 150 to 250 min/wk with a diet
PA <150 min/wk promotes minimal weight loss,- !!!activity doesn’t contribute to the weight loss greatly but does contribute to health greately!!!!
Research evidence does not support Resistance Training as effective for weight loss with or without diet restriction
What are the benefits of using a stepc-ountign device
Pedometer or accelerometer can be used as:
Motivational tool;
Helps to track progress;
Benchmark for goal setting;
– Week 1: Find your baseline
– Week 2: Set realistic goals (↑20%)
– Track the progress
Steps per day for an adult for weigth loss
12000
What is to be considered when deciding to use pharmacological treatment for weigth loss?
• Adjunct therapy to diet, exercise, behavior- will have side effects, while diet and exercise have no, or very limited
concentrate on diet and exercise first, then add meds, if required
• Evaluatebenefits/risksratio:
– About 5% weight loss vs.
– Costs + side effects + weight rebound after use
What are the most common weight loss meds
– Lipase inhibitors
– Appetite suppressants
Describe orlistat
- Orlistat : Lipase inhibitor (Xenical®)
- Action: nonabsorbed inhibitor of lipase, produces malabsorption of ~30% of ingested fat, if taken before meals
- Efficacy: ~50% of subjects overall, ~4 kg loss > placebo, for up to 2 years. Improved comorbidities.
- Side effects: fatty stools, fecal urgency & incontinence, losses in vitamins A,D,E, K (must take supplements)
Describe appetite suppressants
Action on CNS to decrease appetite and increase satiety
– Serotonin agonists
– Amphetamine derivatives
Prescribed for short term, may cause addiction
Side effects: nausea, dizziness, headaches, difficulty sleeping,
constipation,…
Sibutramine (Meridia®) was withdrawn in 2010 because of CVD events and strokes
What are the recommednations for behavior modifications?
- Gradual, permanent changes in eating and exercise habits = the only way to change weight permanently
- Different approaches work for different people
– Registered Dietitians
– Formal weight loss programs
– Self-help groups
– Community fitness centers
First goals of Behavior Modification in Weight Management
§ Increase awareness to change eating habits § Increase physical activity
§ Alter attitudes
§ Develop support systems
§ Educate about nutrition
(Not weight loss on the scale)
Readiness Assessment
- Behavioral
- Ability to increase physical activity
- Success at previous weight loss attempts
- Ability to practice self control skills
Psychological
- Attitudes about weight loss and changing behavior
- Confidence in ability to lose weight
Environmental
- Social support
- Life circumstances
recommendations for changing eatign habits
- Enhanceself-awareness
- Minimize constant exposure to food
• Interrupt negative behavior chains
path to desirable eating behavior
Nutrition Education tips
- Gradually modify eating habits: target diet quality
- Know portion size, refrain from seconds
- Develop skills to select healthy diets:
- serving sizes, labels, cooking
- Manage special situations: eating out, parties
- Increase awareness of cues to eat
- Avoid hunger: no meal skipping, include snacks + protein
- Treat yourself with tasty foods
- Take time to eat, in good company
weight bias vs weight stigma
weight bias- refers to negative attitudes toward others because of their weigth
weight stigma- refers to stereotypes and labes we assign to peope with obbesity
Forms of a weight bias
- Implicity- unconcious
- Explicit- overt
- Internalized- self stigma
Impact of weigth bias on eatign behaviours
- predicts binge eating
- way of coping: refusal to eat or overeating
cycel of weight bias and weigth gain
Impact of weigth bias on physical activity
Impact of weight bias on healthcare utilization
