Obesity Management Flashcards
Obesity management includes
Dietary nutrition intervention
Medical nutrition therapy
PA
Behavioral approaches
Pharmacological agents
Surgery, psychotherapy
5As of obesity management
Ask permission
Assess their story: goals, classification and disease severity
Advise on management: medical nutrition therapy + exercise or psychological, medication, surgery…etc
Agree on goals
Assist with drivers/barriers
Edmonton Obesity Staging System (EOSS)
Stage 0: no signs or symptoms or limitations related to obesity
Stage 1: Subclinical risk factors, mild symptoms or mild psychological issues which impair wellbeing
Stage 2: Established obesity-related comorbidities, moderate limitations or moderate psychological issues
Stage 3: Significant obesity related organ damage, psych, functional limitation or impairment of wellbeing
Stage 4: Severe obesity-related comorbidities, disabling psych symptoms or functional limitations
4Ms of obesity
During assessment address: Mental, mechanical, metabolic and monetary drivers/complications/barriers to weight management
Guiding principles for practitioners around obesity management
Obesity is a chronic disease and must be addressed by improving health not focusing on weight - improve health outcomes
Early interventions address root causes and remove roadblocks
Best weight may not equal ideal weight
Emphasize positive relationships with food as energy restriction is not sustainable long term
People with obesity at increased risk of micronutrient deficiencies
Non-weight based health indicators to evaluate nutrition interventions with clients
Medical nutrition therapy goals
Cognitive improvements, energy, functional improvements, medical, body composition, appetite related and mental health
changes in eating behavior, weight loss/stabilization, risk reduction, complications reduction, eligibility for surgery and psychosocial adjustment
Weight loss benefits in terms of chronic disease risk reduction
Improved glucose tolerance, insulin sensitivity, blood pressure/volume/CO, sympathetic activity
Normalized TAGs, HDL/LDL ratio
Decreased reliance on meds for glucose lowering, antihypertensive and antihyperlipidemic
Rule of thumb to estimate energy deficit for weight loss?
How is kcal restriction determined?
Limitations to this rule of thumb method
calculate REE, then TEE (using PAL)
subtract 500 kcal from TEE
Calculation: 1lb (454g) WAT = 87% fat = 395g fat = 3500 kcal per week –> -500 kcal/day or -300 kcal/day for slower/more sustainable loss
Limitations: assumes all weight lost is fat, LBM also will be lost, loss is not linear bc plateaus and ↓ REE
How to estimate a target weight?
If loss goal is 10 kg, map out .5 kg loss per week
Aim for a healthy BMI (upper range)
Aim for a modest loss first 5-10%
Best weight is the weight you can achieve while living a healthy lifestyle you can enjoy
Nutrient needs during caloric restriction
Protein requirements
Protein/GI combo effect on weight maintenance
<1200 kcal requires multivitamin supplementation
Protein requirement increases with decreasing calories
–> produces greater reduction in body weight/fat mass and serum TAGs without as much LBM loss (better REE)
While fat decreases (only linoleic acid supplementation at very low kcal)
High protein-low GI shows best weight maintenance over time while all other combinations have weight re-gain
- but not difference in perceived satiety
Common features of National Weight Control Registry
Most have a low energy, low-fat diet with minimal variation
Exercise average 1hr per day
Eat breakfast
Weigh themselves
Watch less than 10hrs of TV per week
Priorities for a balanced diet
No ideal diet or approach
Increase diet quality
Energy deficit
Avoid nutritional deficiencies
Preserve lean mass
Promote long-term adherence
Behavioral and dietary change for life
Health benefits of exercise
PA + diet restriction results
Active adults have 20-35% lower risk of premature mortality
Modest enhancement in PA in sedentary individuals has large improvement in health status
Rates of chronic disease and cancer drop with increasing PA
PA will increase weight loss only if diet restriction is not too severe
Resistance training + caloric restriction is effective for weight loss and retaining LBM during energy restriction
What are the 24hr movement guidelines for 18-64 and 65+
18-64: variety, mod-vig 150 min/week, resistance training 2x per week, several hours light activity, 7-9hrs sleep, <3hr recreational screen time (<8hrs sedentary time)
65+: variety, mod-vig 150 min/week, resistance training 2x per week, challenge balance, several hours light activity (standing), 7-8 hours sleep, <3hr recreational screen time (<8hrs sedentary time)
Difference is including balance challenge and a little less sleep required
Elements of behavioral change
Readiness assessment
Path to Desirable Eating Behavior:
Behavioral change:
↑ awareness (food diaries)
↑ PA, alter attitudes (behavior chain of negative triggers –> change the narrative!)
Develop support systems
Nutrition education and literacy
Readiness assessment to address behavioral, psychological and environmental readiness for change
Path to Desirable Eating Behavior: Build coping skills –> prevent mistakes –> increase confidence –> long term control
