Obesity - Management Strategies Flashcards
Behavioual
Self-monitoring
Stimulus control
Cognitive restructuring
Social support
Behavioural:
Self monitoring
Technology
Immediate feedback
Understand lifestyle choices helpful or harmful
Observe + record - eating, exercise, emotions
Behavioural:
Stimulus control
Eat at table Smaller plates Eat same time + place Healthy snacks available Shoes in place to remind Don’t buy tempting foods
Behavioural:
Cognitive restruction
Cognitive behavioural therapy Helps stop negative cycles Replace all or nothing with realistic ideas Self-efficacy Mindful eating
Behavioural:
Social support
Family, friends
Commercial slimming groups - peer to peer, dynamic, regular contact, learn from others
Dietary
Recommendations Moderate deficit diet Meal replacements Very low calorie diet Considerations 2-day diet Monitoring Menu planning
Dietary:
Recommendations
2000kcal/day
Protein = 15%
Fat = 35%
CHO = 50%
Moderate deficit diet
Intake restricted
Usually 600kcal -> -0.5kg/wk
Weight loss continuing up to 3yr period
Meal replacements
Calorie controlled
Higher weight-loss at 3 months + 1yr (compared to trad diets)
Disadvantages
- not sustainable
- limited flavours/lack variety
- lower satiety
- no behaviour change
Very low calorie diet
Liquid based Reduce fat + CHO <800kcal/d Loss 1.5-2.5kg/wk Max 12 weeks BMI >30 High drop out rate + regain weight
Dietary considerations
Tailor to individual
Fad diets
Change not diet
2-day diet
Low CHO x2days Healthy eating x5days Greater fat loss Intermitted energy restriction Decreased insulin + inflammatory markers (linked to CVD + diabetes)
Dietary
Monitoring
Phases
Regular
Dietary
menu planning
Preferences
Variety
Organised shopping
Physical activity
Benefits Barriers Early years Adults Older Obesity prevention Health at every size
Physical activity
Barriers
Low energy level
Motivation
Physical activity
Benefits
Social
Strengthen body
Prevent major diseases
Physical activity
Early years
Encouraged from birth
Pre-school = 3hrs/day
<5yrs = minimise sedentary for long periods
Physical activity
Adults
2 1/2 hours / week
75mins high intensity
Strength 2x week
Physical activity
Older adults
Any P.A is of benefit
Active daily
Activity that improves balance + coordination
Physical activity
Obesity prevention
45-60 mins/day
Previously obese = 60-90 min/day
Physical activity
Health at every size
Acceptance + healthy lifestyle without dieting
Promotes + attitudes
May never result in weight loss so no decrease disease risk
Promotes ‘not my fault’ thinking
Pharmacological
Human drug trials Suppress appetite Affecting EE Nutrient partitioning Obesity drugs
Pharmacological:
Human drug trials
Phase 1 - tolerability
Phase 2 - proof concept
Phase 3 - large scale multi-centre trials
Phase 4 - long term monitoring
Pharmacological:
Drugs suppress appetite
Sympathomimetics - mimic effect of neurotransmitters of PNS
Noradrenergic - phenteramine (release + block norE uptake)
Serotonergic - fluoxetine (serotonin release)
Combo of N + S
Subitramine - antidepressant re-marketed
Phytocannabinoid antagonists
Pharmacological:
Affecting EE
B-3 adrenergic agonists
Ephedrine - stimulates norA secretion
Pharmacological:
Drugs affecting nutrient partitioning
Glucagon-like peptide-1
Orlistat - behaviour change (side effects), reduces fat absorption, BMI >28 with risk factors or BMI >30
Alli - OTC orlistat
Pharmacological:
Obesity drugs
XLS medical - fibre binds with fat preventing absorption, otc
Ideal - orally active, few side effects, visceral fat decrease, non-toxic, long acting
Others available - fibre pills, diuretics, laxatives, tapeworm pills
Some consider drugs ‘medicalise unhealthy lifestyle’
